Multi-institutional Analysis of 100 Consecutive Patients with COVID-19 and Severe Pulmonary Compromise Treated with Extracorporeal Membrane Oxygenation: Outcomes and Trends Over Time
| Autor: | Kirti Patel, Keshava Rajagopal, Eric A. Tesdahl, Alfred H. Stammers, Anthony K. Sestokas, Faisal H. Cheema, Vinay Badhwar, Michael S. Firstenberg, Marvin J. Slepian, J.W. Awori Hayanga, Feriel Esseghir, Jeffrey P. Jacobs, James D. St. Louis, Linda B. Mongero, Tom Coley |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male pulmonary failure Coronavirus disease 2019 (COVID-19) medicine.medical_treatment Critical Illness Biomedical Engineering Biophysics coronavirus heart failure Bioengineering 030204 cardiovascular system & hematology outcomes Biomaterials Cohort Studies 03 medical and health sciences 0302 clinical medicine Extracorporeal membrane oxygenation medicine Humans Prospective Studies Prospective cohort study Aged business.industry Management of COVID-19 Patients SARS-CoV-2 COVID-19 Hydroxychloroquine General Medicine extracorporeal membrane oxygenation acute respiratory distress syndrome Middle Aged medicine.disease surgical procedures operative 030228 respiratory system quality Anesthesia Heart failure Cohort Female Intravenous steroids business medicine.drug Cohort study |
| Zdroj: | Asaio Journal |
| ISSN: | 1538-943X 1058-2916 |
| Popis: | The role of extracorporeal membrane oxygenation (ECMO) in the management of severely ill patients with coronavirus disease 2019 (COVID-19) continues to evolve. The purpose of this study is to review a multi-institutional clinical experience in 100 consecutive patients, at 20 hospitals, with confirmed COVID-19 supported with ECMO. This analysis includes our first 100 patients with complete data who had confirmed COVID-19 and were supported with ECMO. The first patient in the cohort was placed on ECMO on March 17, 2020. Differences by the mortality group were assessed using χ2 tests for categorical variables and Kruskal-Wallis rank-sum tests and Welch's analysis of variance for continuous variables. The median time on ECMO was 12.0 days (IQR = 8-22 days). All 100 patients have since been separated from ECMO: 50 patients survived and 50 patients died. The rate of survival with veno-venous ECMO was 49 of 96 patients (51%), whereas that with veno-arterial ECMO was 1 of 4 patients (25%). Of 50 survivors, 49 have been discharged from the hospital and 1 remains hospitalized at the ECMO-providing hospital. Survivors were generally younger, with a lower median age (47 versus 56.5 years, p = 0.014). In the 50 surviving patients, adjunctive therapies while on ECMO included intravenous steroids (26), anti-interleukin-6 receptor blockers (26), convalescent plasma (22), remdesivir (21), hydroxychloroquine (20), and prostaglandin (15). Extracorporeal membrane oxygenation may facilitate salvage and survival of selected critically ill patients with COVID-19. Survivors tend to be younger. Substantial variation exists in the drug treatment of COVID-19, but ECMO offers a reasonable rescue strategy. |
| Databáze: | OpenAIRE |
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