体外膜肺氧合在 COVID-19 所致严重呼吸衰竭患者中的应用。
Extracorporeal membrane oxygenation in patients with severe respiratory failure from COVID-19.
机构信息
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA, 02215, USA.
Department of Internal Medicine, Hackensack Meridian School of Medicine at Seton Hall, Nutley, NJ, USA.
出版信息
Intensive Care Med. 2021 Feb;47(2):208-221. doi: 10.1007/s00134-020-06331-9. Epub 2021 Feb 2.
PURPOSE
Limited data are available on venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe hypoxemic respiratory failure from coronavirus disease 2019 (COVID-19).
METHODS
We examined the clinical features and outcomes of 190 patients treated with ECMO within 14 days of ICU admission, using data from a multicenter cohort study of 5122 critically ill adults with COVID-19 admitted to 68 hospitals across the United States. To estimate the effect of ECMO on mortality, we emulated a target trial of ECMO receipt versus no ECMO receipt within 7 days of ICU admission among mechanically ventilated patients with severe hypoxemia (PaO/FiO < 100). Patients were followed until hospital discharge, death, or a minimum of 60 days. We adjusted for confounding using a multivariable Cox model.
RESULTS
Among the 190 patients treated with ECMO, the median age was 49 years (IQR 41-58), 137 (72.1%) were men, and the median PaO/FiO prior to ECMO initiation was 72 (IQR 61-90). At 60 days, 63 patients (33.2%) had died, 94 (49.5%) were discharged, and 33 (17.4%) remained hospitalized. Among the 1297 patients eligible for the target trial emulation, 45 of the 130 (34.6%) who received ECMO died, and 553 of the 1167 (47.4%) who did not receive ECMO died. In the primary analysis, patients who received ECMO had lower mortality than those who did not (HR 0.55; 95% CI 0.41-0.74). Results were similar in a secondary analysis limited to patients with PaO/FiO < 80 (HR 0.55; 95% CI 0.40-0.77).
CONCLUSION
In select patients with severe respiratory failure from COVID-19, ECMO may reduce mortality.
目的
关于新冠肺炎（COVID-19）导致的严重低氧性呼吸衰竭患者应用静脉-静脉体外膜肺氧合（ECMO）的数据十分有限。
方法
我们使用美国 68 家医院收治的 5122 例 COVID-19 危重症成年患者的多中心队列研究数据，分析了 190 例在入住 ICU 14 天内接受 ECMO 治疗患者的临床特征和结局。为了评估 ECMO 对死亡率的影响，我们在 ICU 入住后 7 天内接受机械通气且存在严重低氧血症（PaO/FiO<100）的患者中模拟了 ECMO 与不接受 ECMO 之间的目标试验。患者随访至出院、死亡或至少 60 天。我们使用多变量 Cox 模型进行混杂因素校正。
结果
在接受 ECMO 治疗的 190 例患者中，中位年龄为 49 岁（IQR 4158 岁），137 例（72.1%）为男性，ECMO 启动前的中位 PaO/FiO 为 72（IQR 6190）。60 天时，63 例（33.2%）患者死亡，94 例（49.5%）出院，33 例（17.4%）仍住院。在可进行目标试验模拟的 1297 例患者中，接受 ECMO 的 130 例患者中有 45 例（34.6%）死亡，未接受 ECMO 的 1167 例患者中有 553 例（47.4%）死亡。在主要分析中，接受 ECMO 治疗的患者死亡率低于未接受 ECMO 治疗的患者（HR 0.55；95%CI 0.410.74）。在仅限于 PaO/FiO<80 的患者的二次分析中，结果相似（HR 0.55；95%CI 0.400.77）。
结论
在患有严重 COVID-19 所致呼吸衰竭的特定患者中，ECMO 可能降低死亡率。
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