Fragao-Marques Mariana, Barroso Isaac, Loureiro Hugo, Duarte-Gamas Luis, Pinheiro Dolores, Guimarães João T
Clin Lab. 2021 May 1;67(5). doi: 10.7754/Clin.Lab.2020.200916.
Extracorporeal membrane oxygenation (ECMO), could be extremely helpful in the management of COVID-19 patients with refractory hypoxemic respiratory failure; however, to date, evidence on the true effecttiveness of ECMO in the COVID19 setting still hangs in the balance.
This was a prospective cohort study of 39 COVID-19 patients admitted to the intensive care unit (ICU) in an experienced ECMO center at a tertiary hospital during March/April 2020. Among the recruited participants, 10 (25.6%) required ECMO (ICU-ECMO group) and 29 (74.4%) did not have ECMO support (ICU group). Immunological parameters were assessed both at ICU admission and on a daily basis for 7 consecutive days.
The absolute lymphocyte count increased significantly in the ICU-ECMO group compared to the ICU group in which it remained relatively stable: β for the time variable was 127.1 [95% CI 68.9 - 185.3], p < 0.001 and for the interaction term -141.36 [-208.95 - -73.77], p < 0.001. On the other hand, globally, no significant differences were observed over time for the lymphocyte percentage, although it was higher in the ICU patients. Neutrophil counts were overall higher in the ICU-ECMO group (β -4,275.38 [-6,845.21 - 1,705.55], p = 0.001). In regard to neutrophil percentage, a significant decrease over time was reported (β -1.76 [-3.16 - -0.36], p = 0.014), namely in the ICU-ECMO group (β for the interaction 2.09 [0.45 - 3.73], p = 0.013).
Herein, we found ECMO support seems to provide a less aggressive immune response in COVID-19 patients with severe and refractory respiratory dysfunction.
体外膜肺氧合（ECMO）对治疗患有难治性低氧性呼吸衰竭的新型冠状病毒肺炎（COVID-19）患者可能极为有用；然而，迄今为止，关于ECMO在COVID-19情况下的真正有效性的证据仍悬而未决。
这是一项前瞻性队列研究，研究对象为2020年3月/4月期间在一家三级医院的经验丰富的ECMO中心入住重症监护病房（ICU）的39例COVID-19患者。在招募的参与者中，10例（25.6%）需要ECMO（ICU-ECMO组），29例（74.4%）未接受ECMO支持（ICU组）。在ICU入院时以及连续7天每天评估免疫参数。
与ICU组相比，ICU-ECMO组的绝对淋巴细胞计数显著增加，而ICU组的该指标保持相对稳定：时间变量的β值为127.1[95%置信区间68.9 - 185.3]，p<0.001，交互项的β值为-141.36[-208.95 - -73.77]，p<0.001。另一方面，总体而言，淋巴细胞百分比随时间未观察到显著差异，尽管ICU患者中的该指标较高。ICU-ECMO组的中性粒细胞计数总体较高（β -4275.38[-6845.21 - 1705.55]，p = 0.001）。关于中性粒细胞百分比，报告称随时间有显著下降（β -1.76[-3.16 - -0.36]，p = 0.014），即在ICU-ECMO组中（交互项的β值为2.09[0.45 - 3.73]，p = 0.013）。
在此，我们发现ECMO支持似乎在患有严重难治性呼吸功能障碍的COVID-19患者中提供了较不激进的免疫反应。
