Centre for Thrombosis and Haemostasis, Department of Haematology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom.
Department of Critical Care, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom.
Crit Care Med. 2021 Jul 1;49(7):e663-e672. doi: 10.1097/CCM.0000000000004971.
Extracorporeal membrane oxygenation is a lifesaving therapy for patients with severe acute respiratory distress syndrome refractory to conventional mechanical ventilation. It is frequently complicated by both thrombosis and hemorrhage. A markedly prothrombotic state associated with high rates of venous thromboembolism has been described in patients with severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019) infection. These rates have currently not been described during extracorporeal membrane oxygenation in comparison to other viral pneumonias.
Retrospective observational study.
Single high-volume tertiary critical care department at a university hospital.
Patients 16 years old or greater receiving venovenous extracorporeal membrane oxygenation between March 1, 2020, and May 31, 2020, with coronavirus disease 2019 were compared with a cohort of patients with influenza pneumonia between June 1, 2012, and May 31, 2020.
None.
The rates of venous thromboembolism and hemorrhage were compared in patients with coronavirus disease 2019 against a historic population of patients with influenza pneumonia who required extracorporeal membrane oxygenation. There were 51 patients who received extracorporeal membrane oxygenation due to coronavirus disease 2019 and 80 patients with influenza. At cannulation for extracorporeal membrane oxygenation, 37% of patients with coronavirus disease 2019 compared with 8% of patients with influenza had filling defects on CT pulmonary angiography (p = 0.0001). Catheter-associated deep vein thrombosis shown on ultrasound Doppler after decannulation was present in 53% with coronavirus disease 2019 versus 25% with influenza (p = 0.01). The rates of intracranial hemorrhage at the time of cannulation were 16% with coronavirus disease 2019 and 14% with influenza (p = 0.8). Elevated d-dimer levels were seen in both conditions and were significantly higher in those with pulmonary thromboembolism than those without in coronavirus disease 2019 (p = 0.02). Fibrinogen and C-reactive protein levels were significantly higher in those with coronavirus disease 2019 than influenza (p < 0.01).
Significant rates of pulmonary thromboembolism and of catheter-associated deep vein thrombosis were seen in both viral infections but were greater in those requiring the use of extracorporeal membrane oxygenation in coronavirus disease 2019 than for influenza.
体外膜肺氧合是治疗对常规机械通气无反应的严重急性呼吸窘迫综合征患者的救生疗法。它经常同时并发血栓形成和出血。与严重急性呼吸综合征冠状病毒 2（COVID-19）感染患者相关的明显促血栓形成状态与高静脉血栓栓塞率有关。目前，与其他病毒性肺炎相比，尚未在体外膜肺氧合期间对 COVID-19 患者的这些比率进行描述。
回顾性观察性研究。
一所大学医院的单一大容量三级重症监护病房。
2020 年 3 月 1 日至 2020 年 5 月 31 日期间接受静脉-静脉体外膜肺氧合治疗的年龄在 16 岁或以上的 COVID-19 患者，与 2012 年 6 月 1 日至 2020 年 5 月 31 日期间接受流感肺炎治疗的队列患者进行了比较。
无。
将 COVID-19 患者的静脉血栓栓塞和出血率与需要体外膜肺氧合的流感肺炎患者的历史人群进行比较。有 51 例 COVID-19 患者接受了体外膜肺氧合治疗，80 例流感患者。在体外膜肺氧合插管时，37%的 COVID-19 患者与 8%的流感患者的 CT 肺动脉造影显示充盈缺损（p=0.0001）。体外膜肺氧合脱管后，53%的 COVID-19 患者与 25%的流感患者出现超声多普勒导管相关深静脉血栓形成（p=0.01）。插管时颅内出血的发生率为 COVID-19 患者为 16%，流感患者为 14%（p=0.8）。两种情况下均可见 D-二聚体水平升高，且 COVID-19 患者的肺血栓栓塞症患者高于无肺血栓栓塞症患者（p=0.02）。COVID-19 患者的纤维蛋白原和 C 反应蛋白水平明显高于流感患者（p<0.01）。
两种病毒感染均可见显著的肺血栓栓塞症和导管相关深静脉血栓形成发生率，但 COVID-19 患者需要使用体外膜肺氧合治疗的发生率高于流感患者。
