Venovenous extracorporeal membrane oxygenation for patients with refractory coronavirus disease 2019 (COVID-19): Multicenter experience of referral hospitals in a large health care system
| Autor: | Britton Blough, Chris Martin, J. Michael DiMaio, Emily Shih, Kara Monday, Robert L. Gottlieb, Anita Krueger, Jorge F. Velazco, Gary S. Schwartz, Timothy J. George, John J. Squiers, Jasjit K. Banwait, G.V. Gonzalez-Stawinski, Omar Hernandez, Ramachandra C Reddy, Dan M. Meyer, Jenelle Sheasby |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
VA
(venoarterial) Male ARDS LOS (length of stay) medicine.medical_treatment 030204 cardiovascular system & hematology law.invention Tertiary Care Centers 0302 clinical medicine Interquartile range law Fraction of inspired oxygen Acute care ARDS (acute respiratory distress syndrome) COPD (chronic obstructive pulmonary disease) ALT (alanine transaminase) Coronavirus (COVID-19) SD (standard deviation) Middle Aged Intensive care unit ICU (intensive care unit) Treatment Outcome surgical procedures operative CRP (C-reactive protein) VV (venovenous) CI (cardiac index) Disease Progression LDH (lactate dehydrogenase) Female Cardiology and Cardiovascular Medicine IL-6 (interleukin-6) INR (international normalized ratio) Adult Pulmonary and Respiratory Medicine medicine.medical_specialty Critical Care ECMO (extracorporeal membrane oxygenation) Article Extracorporeal Membrane Oxygenation (ECMO) 03 medical and health sciences Extracorporeal Membrane Oxygenation WBC (white blood cell count) Refractory Extracorporeal membrane oxygenation medicine Humans IQR (interquartile range) Secondary Care Centers Aged Retrospective Studies Mechanical ventilation business.industry Patient Acuity COVID-19 medicine.disease Survival Analysis Acute Respiratory Distress Syndrome (ARDS) 030228 respiratory system Emergency medicine Surgery business Follow-Up Studies |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2020.11.073 |
| Popis: | Background The benefit of extracorporeal membrane oxygenation (ECMO) for patients with severe acute respiratory distress from COVID-19 refractory to medical management and lung-protective mechanical ventilation has not been adequately determined. Methods We reviewed the clinical course of 37 patients with laboratory-confirmed SARS-CoV-2 infection supported by venovenous ECMO at four ECMO referral centers within a large healthcare system. Patient characteristics, progression of hemodynamics and inflammatory markers, and clinical outcomes were evaluated. Results The patients had median age of 51 years (interquartile range [IQR] 40-59), and 73% were male. Peak plateau pressures, vasopressor requirements, and arterial PaCO2 all improved with ECMO support. In our patient population, 24/37 patients (64.8%) survived to decannulation and 21/37 patients (56.8%) survived to discharge. Among patients discharged alive from the ECMO facility, 12 patients were discharged to a long-term acute care or rehabilitation facility, 2 were transferred back to the referring hospital for ventilatory weaning, and 7 were discharged directly home. For patients who were successfully decannulated, median length of time on ECMO was 17 days (IQR 10-33.5). Conclusions Venovenous ECMO represents a useful therapy for patients with refractory severe acute respiratory distress syndrome from COVID-19. Graphical abstract |
| Databáze: | OpenAIRE |
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