Riera Jordi, Argudo Eduard, Martínez-Martínez María, García Sandra, García-de-Acilu Marina, Santafé Manel, Díaz Cándido, Contreras Sofía, Cortina Alexandra, Bonilla Camilo, Pacheco Andrés, Resta Paula, Palmer Neiser, Castro Miguel Ángel, Ferrer Ricard
Department of Critical Care, Vall d'Hebron University Hospital, Barcelona, Spain.
SODIR, Vall d'Hebron Research Institute, Barcelona, Spain.
Crit Care Explor. 2020 Sep 28;2(10):e0228. doi: 10.1097/CCE.0000000000000228. eCollection 2020 Oct.
To evaluate the performance of the extracorporeal membrane oxygenation retrieval team at a high-volume extracorporeal membrane oxygenation center during the coronavirus disease 2019 pandemic.
Observational study including all adult patients with confirmed infection due to severe acute respiratory syndrome coronavirus-2 cannulated at other centers and transported on extracorporeal membrane oxygenation to the ICU of the Vall d'Hebron University Hospital between 15 March and 10 June 2020.
The ICU (capacity expanded to 200 during the pandemic) of the Vall d'Hebron University Hospital (a 1,100-bed public university hospital in Barcelona), the referral center for extracorporeal respiratory support in Catalonia (7.5 million inhabitants).
Extracorporeal membrane oxygenation was considered if the Pao/Fio ratio less than 80 mm Hg (refractory to prone position) and/or Paco greater than 80 mm Hg and pH less than 7.25 for more than 6 hours, and no contraindications for extracorporeal support were present.
Venovenous extracorporeal membrane oxygenation was initiated in the primary center. Then, patients were transferred to the ICU of the Vall d'Hebron University Hospital where they received support until respiratory improvement. After decannulation, patients were discharged for rehabilitation at the primary center.
Nineteen patients with severe acute respiratory syndrome coronavirus-2 infection and with a mean Pao/Fio ratio of 71 mm Hg (57-118 mm Hg) despite prone positioning and a mean Paco of 70 mm Hg (47-110 mm Hg) were transferred to our center from their primary hospital after cannulation and received venovenous extracorporeal membrane oxygenation support. Prior to cannulation, six patients (31.5%) presented vascular thrombosis, and nine (47.4%) were already receiving anticoagulant therapy. Eighteen transfers were carried out with no significant complications. While on extracorporeal membrane oxygenation, thrombotic events were recorded in nine patients (47.4%) and hemorrhagic events in 13 (68.4%). Thirteen patients (68.4%) were successfully weaned, and 12 (63.1%) were discharged home.
Extracorporeal membrane oxygenation retrieval can rescue young, previously healthy patients with severe coronavirus disease 2019 in whom all the conventional respiratory measures have failed. Thrombotic and hemorrhagic complications are frequent in this cohort.
评估在2019冠状病毒病大流行期间，一家大容量体外膜肺氧合中心的体外膜肺氧合转运团队的工作表现。
观察性研究，纳入2020年3月15日至6月10日期间在其他中心接受插管并通过体外膜肺氧合转运至巴塞罗那瓦尔德希伯伦大学医院重症监护病房的所有确诊感染严重急性呼吸综合征冠状病毒2的成年患者。
巴塞罗那瓦尔德希伯伦大学医院的重症监护病房（大流行期间容量扩大至200张床位），这是加泰罗尼亚（750万居民）体外呼吸支持的转诊中心。
如果动脉血氧分压/吸氧浓度（Pao/Fio）比值低于80mmHg（俯卧位无效）和/或动脉血二氧化碳分压（Paco）高于80mmHg且pH值低于7.25持续超过6小时，且不存在体外支持的禁忌证，则考虑进行体外膜肺氧合。
在原中心启动静脉-静脉体外膜肺氧合。然后，患者被转至瓦尔德希伯伦大学医院重症监护病房，在那里接受支持直至呼吸改善。拔管后，患者返回原中心进行康复出院。
19例严重急性呼吸综合征冠状病毒2感染患者，尽管采用俯卧位，平均Pao/Fio比值仍为71mmHg（57-118mmHg），平均Paco为70mmHg（47-110mmHg），插管后从原医院转至我院，接受静脉-静脉体外膜肺氧合支持。插管前，6例患者（31.5%）出现血管血栓形成，9例（47.4%）已在接受抗凝治疗。18次转运均无明显并发症。在接受体外膜肺氧合期间，9例患者（47.4%）记录有血栓事件，13例（68.4%）有出血事件。13例患者（68.4%）成功脱机，12例（63.1%）出院回家。
体外膜肺氧合转运可挽救所有传统呼吸措施均无效的年轻、既往健康的重症2019冠状病毒病患者。该队列中血栓形成和出血并发症较为常见。
