Variation in outcomes with extracorporeal membrane oxygenation in the era of coronavirus: A multicenter cohort evaluation.

Autor:	Stammers AH; Medical Department, SpecialtyCare, Brentwood, TN, USA., Tesdahl EA; Medical Department, SpecialtyCare, Brentwood, TN, USA., Sestokas AK; Medical Department, SpecialtyCare, Brentwood, TN, USA., Mongero LB; Medical Department, SpecialtyCare, Brentwood, TN, USA., Patel K; Medical Department, SpecialtyCare, Brentwood, TN, USA., Barletti S; Perfusion Department, Thomas Jefferson University Hospital, Philadelphia, PA, USA., Firstenberg MS; Cardiothoracic Surgery, St. Elizabeth Medical Center, Appleton, WI, USA., St Louis JD; Children's Hospital of Georgia, Augusta, GA, USA., Jain A; Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta, GA, USA., Bailey C; Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta, GA, USA., Jacobs JP; Congenital Heart Center, Division of Cardiovascular Surgery, University of Florida, Gainesville, FL, USA., Weinstein S; Medical Department, SpecialtyCare, Brentwood, TN, USA.
Jazyk:	angličtina
Zdroj:	Perfusion [Perfusion] 2023 Oct; Vol. 38 (7), pp. 1501-1510. Date of Electronic Publication: 2022 Aug 09.
DOI:	10.1177/02676591221118321
Abstrakt:	Extracorporeal membrane oxygenation (ECMO) is used in critically ill patients with coronavirus disease 2019 (COVID-19) with acute respiratory distress syndrome unresponsive to other interventions. However, a COVID-19 infection may result in a differential tolerance to both medical treatment and ECMO management. The aim of this study was to compare outcomes (mortality, organ failure, circuit complications) in patients on ECMO with and without COVID-19 infection, either by venovenous (VV) or venoarterial (VA) cannulation. This is a multicenter, retrospective analysis of a national database of patients placed on ECMO between May 2020 and January 2022 within the United States. Nine-hundred thirty patients were classified as either Pulmonary (PULM, n = 206), Cardiac (CARD, n = 279) or COVID-19 (COVID, n = 445). Patients were younger in COVID groups: PULM = 48.4 ± 15.8 years versus COVID = 44.9 ± 12.3 years, p = 0.006, and CARD = 57.9 ± 15.4 versus COVID = 46.5 ± 11.8 years, p < 0.001. Total hours on ECMO were greatest for COVID patients with a median support time two-times higher for VV support (365 [101, 657] hours vs 183 [63, 361], p < 0.001), and three times longer for VA support (212 [99, 566] hours vs 70 [17, 159], p < 0.001). Mortality was highest for COVID patients for both cannulation types (VA-70% vs 51% in CARD, p = 0.041, and VV-59% vs PULM-42%, p < 0.001). For VA supported patients hepatic failure was more often seen with COVID patients, while for VV support renal failure was higher. Circuit complications were more frequent in the COVID group as compared to both CARD and PULM with significantly higher circuit change-outs, circuit thromboses and oxygenator failures. Anticoagulation with direct thrombin inhibitors was used more often in COVID compared to both CARD (31% vs 10%, p = 0.002) and PULM (43% vs 15%, p < 0.001) groups. This multicenter observational study has shown that COVID patients on ECMO had higher support times, greater hospital mortality and higher circuit complications, when compared to patients managed for either cardiac or pulmonary lesions. Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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