Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: a retrospective cohort study.
Journal
The Lancet. Respiratory medicine
ISSN: 2213-2619
Titre abrégé: Lancet Respir Med
Pays: England
ID NLM: 101605555
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
03
06
2020
revised:
13
07
2020
accepted:
15
07
2020
pubmed:
18
8
2020
medline:
18
11
2020
entrez:
18
8
2020
Statut:
ppublish
Résumé
Patients with COVID-19 who develop severe acute respiratory distress syndrome (ARDS) can have symptoms that rapidly evolve to profound hypoxaemia and death. The efficacy of extracorporeal membrane oxygenation (ECMO) for patients with severe ARDS in the context of COVID-19 is unclear. We aimed to establish the clinical characteristics and outcomes of patients with respiratory failure and COVID-19 treated with ECMO. This retrospective cohort study was done in the Paris-Sorbonne University Hospital Network, comprising five intensive care units (ICUs) and included patients who received ECMO for COVID-19 associated ARDS. Patient demographics and daily pre-ECMO and on-ECMO data and outcomes were collected. Possible outcomes over time were categorised into four different states (states 1-4): on ECMO, in the ICU and weaned off ECMO, alive and out of ICU, or death. Daily probabilities of occupation in each state and of transitions between these states until day 90 post-ECMO onset were estimated with use of a multi-state Cox model stratified for each possible transition. Follow-up was right-censored on July 10, 2020. From March 8 to May 2, 2020, 492 patients with COVID-19 were treated in our ICUs. Complete day-60 follow-up was available for 83 patients (median age 49 [IQR 41-56] years and 61 [73%] men) who received ECMO. Pre-ECMO, 78 (94%) patients had been prone-positioned; their median driving pressure was 18 (IQR 16-21) cm H The estimated 60-day survival of ECMO-rescued patients with COVID-19 was similar to that of studies published in the past 2 years on ECMO for severe ARDS. If another COVID-19 outbreak occurs, ECMO should be considered for patients developing refractory respiratory failure despite optimised care. None.
Sections du résumé
BACKGROUND
Patients with COVID-19 who develop severe acute respiratory distress syndrome (ARDS) can have symptoms that rapidly evolve to profound hypoxaemia and death. The efficacy of extracorporeal membrane oxygenation (ECMO) for patients with severe ARDS in the context of COVID-19 is unclear. We aimed to establish the clinical characteristics and outcomes of patients with respiratory failure and COVID-19 treated with ECMO.
METHODS
This retrospective cohort study was done in the Paris-Sorbonne University Hospital Network, comprising five intensive care units (ICUs) and included patients who received ECMO for COVID-19 associated ARDS. Patient demographics and daily pre-ECMO and on-ECMO data and outcomes were collected. Possible outcomes over time were categorised into four different states (states 1-4): on ECMO, in the ICU and weaned off ECMO, alive and out of ICU, or death. Daily probabilities of occupation in each state and of transitions between these states until day 90 post-ECMO onset were estimated with use of a multi-state Cox model stratified for each possible transition. Follow-up was right-censored on July 10, 2020.
FINDINGS
From March 8 to May 2, 2020, 492 patients with COVID-19 were treated in our ICUs. Complete day-60 follow-up was available for 83 patients (median age 49 [IQR 41-56] years and 61 [73%] men) who received ECMO. Pre-ECMO, 78 (94%) patients had been prone-positioned; their median driving pressure was 18 (IQR 16-21) cm H
INTERPRETATION
The estimated 60-day survival of ECMO-rescued patients with COVID-19 was similar to that of studies published in the past 2 years on ECMO for severe ARDS. If another COVID-19 outbreak occurs, ECMO should be considered for patients developing refractory respiratory failure despite optimised care.
FUNDING
None.
Identifiants
pubmed: 32798468
pii: S2213-2600(20)30328-3
doi: 10.1016/S2213-2600(20)30328-3
pmc: PMC7426089
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1121-1131Investigateurs
Charles-Edouard Luyt
(CE)
Guillaume Hekimian
(G)
Nicolas Brechot
(N)
Marc Pineton de Chambrun
(M)
Cyrielle Desnos
(C)
Jeremy Arzoine
(J)
Emmanuelle Guerin
(E)
Thibaut Schoell
(T)
Pierre Demondion
(P)
Charles Juvin
(C)
Nathalie Nardonne
(N)
Sofica Marin
(S)
Cossimo D'Alessandro
(C)
Bao-Long Nguyen
(BL)
Cyril Quemeneur
(C)
Arthur James
(A)
Mona Assefi
(M)
Victoria Lepere
(V)
Guillaume Savary
(G)
Aude Gibelin
(A)
Matthieu Turpin
(M)
Alexandre Elabbadi
(A)
Enora Berti
(E)
Corinne Vezinet
(C)
Harold Bonvallot
(H)
Pierre-Romain Delmotte
(PR)
Martin De Sarcus
(M)
Charlotte Du Fayet De La Tour
(C)
Samia Abbas
(S)
Eric Maury
(E)
Jean-Luc Baudel
(JL)
Jean-Remi Lavillegrand
(JR)
Hafid Ait Oufella
(H)
Abdelmalek Abdelkrim
(A)
Thomas Urbina
(T)
Sara Virolle
(S)
Robin Deleris
(R)
Vincent Bonny
(V)
Julien Le Marec
(J)
Julien Mayaux
(J)
Elise Morawiec
(E)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 Elsevier Ltd. All rights reserved.
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