Alshahrani Mohammed S, Sindi Anees, Alshamsi Fayez, Al-Omari Awad, El Tahan Mohamed, Alahmadi Bayan, Zein Ahmed, Khatani Naif, Al-Hameed Fahad, Alamri Sultan, Abdelzaher Mohammed, Alghamdi Amenah, Alfousan Faisal, Tash Adel, Tashkandi Wail, Alraddadi Rajaa, Lewis Kim, Badawee Mohammed, Arabi Yaseen M, Fan Eddy, Alhazzani Waleed
Department of Emergency and Critical Care, King Fahad Hospital of the University-Dammam University, PO Box 40236, Al Khobar, 31952, Saudi Arabia.
Department of Medicine/Intensive Care, King Abdulaziz University, Jeddah, Saudi Arabia.
Ann Intensive Care. 2018 Jan 10;8(1):3. doi: 10.1186/s13613-017-0350-x.
Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS-CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in severely hypoxemic patients who failed conventional strategies.
We collected data retrospectively on MERS-CoV patients with refractory respiratory failure from April 2014 to December 2015 in 5 intensive care units (ICUs) in Saudi Arabia. Patients were classified into two groups: ECMO versus conventional therapy. Our primary outcome was in-hospital mortality; secondary outcomes included ICU and hospital length of stay.
Thirty-five patients were included; 17 received ECMO and 18 received conventional therapy. Both groups had similar baseline characteristics. The ECMO group had lower in-hospital mortality (65 vs. 100%, P = 0.02), longer ICU stay (median 25 vs. 8 days, respectively, P < 0.01), and similar hospital stay (median 41 vs. 31 days, P = 0.421). In addition, patients in the ECMO group had better PaO2/FiO2 at days 7 and 14 of admission to the ICU (124 vs. 63, and 138 vs. 36, P < 0.05), and less use of norepinephrine at days 1 and 14 (29 vs. 80%; and 36 vs. 93%, P < 0.05).
ECMO use, as a rescue therapy, was associated with lower mortality in MERS patients with refractory hypoxemia. The results of this, largest to date, support the use of ECMO as a rescue therapy in patients with severe MERS-CoV.
中东呼吸综合征（MERS）由一种冠状病毒（MERS-CoV）引起，其特征为低氧性呼吸衰竭。本研究的目的是比较体外膜肺氧合（ECMO）作为一种挽救治疗手段应用于常规策略治疗失败的严重低氧患者前后，MERS-CoV患者的治疗结局。
我们回顾性收集了2014年4月至2015年12月在沙特阿拉伯5个重症监护病房（ICU）中患有难治性呼吸衰竭的MERS-CoV患者的数据。患者被分为两组：ECMO组与常规治疗组。我们的主要结局是住院死亡率；次要结局包括ICU住院时间和总住院时间。
共纳入35例患者；17例接受了ECMO治疗，18例接受了常规治疗。两组患者的基线特征相似。ECMO组的住院死亡率较低（分别为65%和100%，P = 0.02），ICU住院时间更长（中位数分别为25天和8天，P < 0.01），总住院时间相似（中位数分别为41天和31天，P = 0.421）。此外，ECMO组患者在入住ICU第7天和第14天时的氧合指数（PaO2/FiO2）更好（分别为124和63，以及138和36，P < 0.05），在第1天和第14天时去甲肾上腺素的使用量更少（分别为29%和80%；以及36%和93%，P < 0.05）。
作为一种挽救治疗手段，使用ECMO与难治性低氧血症的MERS患者死亡率降低相关。这项迄今为止规模最大的研究结果支持将ECMO作为重症MERS-CoV患者的挽救治疗手段。
