Alnababteh Muhtadi, Hashmi Muhammad D, Vedantam Karthik, Chopra Rajus, Kohli Akshay, Hayat Fatima, Kriner Eric, Molina Ezequiel, Pratt Alexandra, Oweis Emil, Zaaqoq Akram M
Department of Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC, USA.
Critical Care Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC, USA.
Perfusion. 2021 Sep;36(6):564-572. doi: 10.1177/0267659120963885. Epub 2020 Oct 6.
The pandemic of the coronavirus disease 2019 (COVID-19) and associated pneumonia represent a clinical and scientific challenge. The role of Extracorporeal Membrane Oxygenation (ECMO) in such a crisis remains unclear.
We examined COVID-19 patients who were supported for acute respiratory failure by both conventional mechanical ventilation (MV) and ECMO at a tertiary care institution in Washington DC. The study period extended from March 23 to April 29. We identified 59 patients who required invasive mechanical ventilation. Of those, 13 patients required ECMO.
Nine out of 13 ECMO (69.2%) patients were decannulated from ECMO. All-cause ICU mortality was comparable between both ECMO and MV groups (6 patients [46.15%] vs. 22 patients [47.82 %], p = 0.92). ECMO non-survivors vs survivors had elevated D-dimer (9.740 mcg/ml [4.84-20.00] vs. 3.800 mcg/ml [2.19-9.11], p = 0.05), LDH (1158 ± 344.5 units/L vs. 575.9 ± 124.0 units/L, p = 0.001), and troponin (0.4315 ± 0.465 ng/ml vs. 0.034 ± 0.043 ng/ml, p = 0.04). Time on MV as expected was significantly longer in ECMO groups (563.3 hours [422.1-613.9] vs. 247.9 hours [101.8-479] in MV group, p = 0.0009) as well as ICU length of stay 576.2 hours [457.5-652.8] in ECMO group vs. 322.2 hours [120.6-569.3] in MV group, p = 0.012).
ECMO is a supportive intervention for COVID-19 associated pneumonia that could be considered if the optimum mechanical ventilation is deemed ineffective. Biomarkers such as D-dimer, LDH, and troponin could help with discerning the clinical prognosis in patients with COVID-19 pneumonia.
2019年冠状病毒病（COVID-19）大流行及相关肺炎构成了一项临床和科学挑战。体外膜肺氧合（ECMO）在这种危机中的作用仍不明确。
我们研究了在华盛顿特区一家三级医疗机构中接受传统机械通气（MV）和ECMO支持以治疗急性呼吸衰竭的COVID-19患者。研究时间段为3月23日至4月29日。我们确定了59例需要有创机械通气的患者。其中，13例患者需要ECMO。
13例接受ECMO治疗的患者中有9例（69.2%）撤机。ECMO组和MV组的全因重症监护病房死亡率相当（6例[46.15%]对22例[47.82%]，p = 0.92）。与ECMO幸存者相比，非幸存者的D-二聚体水平升高（9.740 mcg/ml[4.84 - 20.00]对3.800 mcg/ml[2.19 - 9.11]，p = 0.05）、乳酸脱氢酶（LDH）水平升高（1158 ± 344.5单位/L对575.9 ± 124.0单位/L，p = 0.001）以及肌钙蛋白水平升高（0.4315 ± 0.465 ng/ml对0.034 ± 0.043 ng/ml，p = 0.04）。正如预期的那样，ECMO组患者的机械通气时间显著更长（563.3小时[422.1 - 613.9]，而MV组为247.9小时[101.8 - 479]，p = 0.0009），ECMO组的重症监护病房住院时长也更长（576.2小时[457.5 - 652.8]，而MV组为322.2小时[120.6 - 569.3]，p = 0.012）。
ECMO是对COVID-19相关肺炎的一种支持性干预措施，如果认为最佳机械通气无效则可考虑使用。D-二聚体、LDH和肌钙蛋白等生物标志物有助于判断COVID-19肺炎患者的临床预后。
