Evolving outcomes of extracorporeal membrane oxygenation support for severe COVID-19 ARDS in Sorbonne hospitals, Paris.

Autor:	Schmidt M; Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France. matthieu.schmidt@aphp.fr.; Service de Médecine Intensive-Réanimation, iCAN, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université Hôpital Pitié-Salpêtrière, 47, Bd de L'Hôpital, 75651, Paris Cedex 13, France. matthieu.schmidt@aphp.fr.; GRC 30, RESPIRE, APHP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France. matthieu.schmidt@aphp.fr., Langouet E; Service de Médecine Intensive-Réanimation, iCAN, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université Hôpital Pitié-Salpêtrière, 47, Bd de L'Hôpital, 75651, Paris Cedex 13, France., Hajage D; INSERM, Institut Pierre-Louis d'Epidémiologie Et de Santé Publique, APHP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, CIC-1421, Paris, France., James SA; Service de Médecine Intensive-Réanimation, iCAN, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université Hôpital Pitié-Salpêtrière, 47, Bd de L'Hôpital, 75651, Paris Cedex 13, France., Chommeloux J; Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France.; Service de Médecine Intensive-Réanimation, iCAN, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université Hôpital Pitié-Salpêtrière, 47, Bd de L'Hôpital, 75651, Paris Cedex 13, France., Bréchot N; Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France.; Service de Médecine Intensive-Réanimation, iCAN, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université Hôpital Pitié-Salpêtrière, 47, Bd de L'Hôpital, 75651, Paris Cedex 13, France., Barhoum P; Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France.; Service de Médecine Intensive-Réanimation, iCAN, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université Hôpital Pitié-Salpêtrière, 47, Bd de L'Hôpital, 75651, Paris Cedex 13, France., Lefèvre L; Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France.; Service de Médecine Intensive-Réanimation, iCAN, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université Hôpital Pitié-Salpêtrière, 47, Bd de L'Hôpital, 75651, Paris Cedex 13, France., Troger A; Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France.; Service de Médecine Intensive-Réanimation, iCAN, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université Hôpital Pitié-Salpêtrière, 47, Bd de L'Hôpital, 75651, Paris Cedex 13, France., de Chambrun MP; Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France.; Service de Médecine Intensive-Réanimation, iCAN, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université Hôpital Pitié-Salpêtrière, 47, Bd de L'Hôpital, 75651, Paris Cedex 13, France., Hékimian G; Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France.; Service de Médecine Intensive-Réanimation, iCAN, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université Hôpital Pitié-Salpêtrière, 47, Bd de L'Hôpital, 75651, Paris Cedex 13, France., Luyt CE; Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France.; Service de Médecine Intensive-Réanimation, iCAN, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université Hôpital Pitié-Salpêtrière, 47, Bd de L'Hôpital, 75651, Paris Cedex 13, France., Dres M; GRC 30, RESPIRE, APHP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France.; APHP, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive-Réanimation (Département 'R3S'), Sorbonne Université, Paris, France.; Inserm, UMRS_1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Sorbonne Université, Paris, France., Constantin JM; GRC 29, APHP, DMU DREAM, Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France., Fartoukh M; GRC 30, RESPIRE, APHP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France.; APHP, Sorbonne Université, Hôpital Tenon, Service de Médecine Intensive Réanimation, Sorbonne Université, Paris, France., Leprince P; Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France.; Service de Chirurgie Cardiaque, Institut de Cardiologie, APHP, Paris, Sorbonne, France., Lebreton G; Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France.; Service de Chirurgie Cardiaque, Institut de Cardiologie, APHP, Paris, Sorbonne, France., Combes A; Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France.; Service de Médecine Intensive-Réanimation, iCAN, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université Hôpital Pitié-Salpêtrière, 47, Bd de L'Hôpital, 75651, Paris Cedex 13, France.; GRC 30, RESPIRE, APHP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France.
Jazyk:	angličtina
Zdroj:	Critical care (London, England) [Crit Care] 2021 Oct 09; Vol. 25 (1), pp. 355. Date of Electronic Publication: 2021 Oct 09.
DOI:	10.1186/s13054-021-03780-6
Abstrakt:	Background: Extracorporeal membrane oxygenation (ECMO) was frequently used to treat patients with severe coronavirus disease-2019 (COVID-19)-associated acute respiratory distress (ARDS) during the initial outbreak. Care of COVID-19 patients evolved markedly during the second part of 2020. Our objective was to compare the characteristics and outcomes of patients who received ECMO for severe COVID-19 ARDS before or after July 1, 2020. Methods: We included consecutive adults diagnosed with COVID-19 in Paris-Sorbonne University Hospital Network ICUs, who received ECMO for severe ARDS until January 28, 2021. Characteristics and survival probabilities over time were estimated during the first and second waves. Pre-ECMO risk factors predicting 90-day mortality were assessed using multivariate Cox regression. Results: Characteristics of the 88 and 71 patients admitted, respectively, before and after July 1, 2020, were comparable except for older age, more frequent use of dexamethasone (18% vs. 82%), high-flow nasal oxygenation (19% vs. 82%) and/or non-invasive ventilation (7% vs. 37%) after July 1. Respective estimated probabilities (95% confidence intervals) of 90-day mortality were 36% (27-47%) and 48% (37-60%) during the first and the second periods. After adjusting for confounders, probability of 90-day mortality was significantly higher for patients treated after July 1 (HR 2.27, 95% CI 1.02-5.07). ECMO-related complications did not differ between study periods. Conclusions: 90-day mortality of ECMO-supported COVID-19-ARDS patients increased significantly after July 1, 2020, and was no longer comparable to that of non-COVID ECMO-treated patients. Failure of prolonged non-invasive oxygenation strategies before intubation and increased lung damage may partly explain this outcome. (© 2021. The Author(s).)
Databáze:	MEDLINE
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