中国武汉有和没有体外膜肺氧合支持的重症 COVID-19 患者的回顾性研究。
Retrospective Study of Critically Ill COVID-19 Patients With and Without Extracorporeal Membrane Oxygenation Support in Wuhan, China.
作者信息
Cheng Wei, Ma Xu-Dong, Su Long-Xiang, Long Yun, Liu Da-Wei, Du Bin, Qiu Hai-Bo, Guan Xiang-Dong, Chen De-Chang, Kang Yan, Tong Zhao-Hui, Peng Zhi-Yong, Shang You, Zheng Rui-Qiang, Li Shu-Sheng, Pan Chun, Huang Xiao-Bo, Zhan Qing-Yuan, Ding Ren-Yu, Huang Chao-Lin, Yin Yong-Jie, Li Sheng-Qing, Li Xu-Yan, Jiang Li, Hu Ming, Li Xin, Zhou Xiang, Jing Zhi-Cheng, Guo Yan-Hong, Zhang Shu-Yang
机构信息
Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, China.
出版信息
Front Med (Lausanne). 2021 Oct 12;8:659793. doi: 10.3389/fmed.2021.659793. eCollection 2021.
Extracorporeal membrane oxygenation (ECMO) might benefit critically ill COVID-19 patients. But the considerations besides indications guiding ECMO initiation under extreme pressure during the COVID-19 epidemic was not clear. We aimed to analyze the clinical characteristics and in-hospital mortality of severe critically ill COVID-19 patients supported with ECMO and without ECMO, exploring potential parameters for guiding the initiation during the COVID-19 epidemic. Observational cohort study of all the critically ill patients indicated for ECMO support from January 1 to May 1, 2020, in all 62 authorized hospitals in Wuhan, China. Among the 168 patients enrolled, 74 patients actually received ECMO support and 94 not were analyzed. The in-hospital mortality of the ECMO supported patients was significantly lower than non-ECMO ones (71.6 vs. 85.1%, = 0.033), but the role of ECMO was affected by patients' age (Logistic regression OR 0.62, = 0.24). As for the ECMO patients, the median age was 58 (47-66) years old and 62.2% (46/74) were male. The 28-day, 60-day, and 90-day mortality of these ECMO supported patients were 32.4, 68.9, and 74.3% respectively. Patients survived to discharge were younger (49 vs. 62 years, = 0.042), demonstrated higher lymphocyte count (886 vs. 638 cells/uL, = 0.022), and better CO removal (PaCO2 immediately after ECMO initiation 39.7 vs. 46.9 mmHg, = 0.041). Age was an independent risk factor for in-hospital mortality of the ECMO supported patients, and a cutoff age of 51 years enabled prediction of in-hospital mortality with a sensitivity of 84.3% and specificity of 55%. The surviving ECMO supported patients had longer ICU and hospital stays (26 vs. 18 days, = 0.018; 49 vs. 29 days, = 0.001 respectively), and ECMO procedure was widely carried out after the supplement of medical resources after February 15 (67.6%, 50/74). ECMO might be a benefit for severe critically ill COVID-19 patients at the early stage of epidemic, although the in-hospital mortality was still high. To initiate ECMO therapy under tremendous pressure, patients' age, lymphocyte count, and adequacy of medical resources should be fully considered.
体外膜肺氧合（ECMO）可能对危重症新型冠状病毒肺炎（COVID-19）患者有益。但在COVID-19疫情期间极端压力下，除了指导启动ECMO的适应证之外的考量尚不清楚。我们旨在分析接受ECMO支持和未接受ECMO支持的重症危重症COVID-19患者的临床特征及院内死亡率，探索在COVID-19疫情期间指导启动ECMO的潜在参数。对2020年1月1日至5月1日在中国武汉所有62家获批医院中所有符合ECMO支持指征的危重症患者进行观察性队列研究。在纳入的168例患者中，74例患者实际接受了ECMO支持，对94例未接受ECMO支持的患者进行分析。接受ECMO支持的患者院内死亡率显著低于未接受ECMO支持的患者（71.6%对85.1%，P = 0.033），但ECMO的作用受患者年龄影响（逻辑回归OR 0.62，P = 0.24）。对于接受ECMO支持的患者，中位年龄为58（47 - 66）岁，62.2%（46/74）为男性。这些接受ECMO支持的患者28天、60天和90天死亡率分别为32.4%、68.9%和74.3%。存活至出院的患者更年轻（49岁对62岁，P = 0.042），淋巴细胞计数更高（886个/μL对638个/μL，P = 0.022），且二氧化碳清除情况更好（ECMO启动后即刻动脉血二氧化碳分压39.7 mmHg对46.9 mmHg，P = 0.041）。年龄是接受ECMO支持患者院内死亡的独立危险因素，51岁的截断值能够预测院内死亡率，敏感性为84.3%，特异性为55%。存活的接受ECMO支持的患者在重症监护病房（ICU）和住院时间更长（分别为26天对18天，P = 0.018；49天对29天，P = 0.001），且在2月15日医疗资源补充后ECMO程序广泛开展（67.6%，50/74）。尽管院内死亡率仍然较高，但ECMO可能对疫情早期的重症危重症COVID-19患者有益。在巨大压力下启动ECMO治疗时，应充分考虑患者年龄、淋巴细胞计数和医疗资源充足情况。
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