Voicu Sebastian, Goury Antoine, Lacoste-Palasset Thomas, Malissin Isabelle, Fanet Lucie, Souissi Samar, Busto Julia, Legros Vincent, Sutterlin Laetitia, Naim Giulia, M'Rad Aymen, Pepin-Lehaleur Adrien, Deye Nicolas, Mourvillier Bruno, Mégarbane Bruno
Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris-University, 75010 Paris, France.
Medical Critical Care Department, Robert Debré University Hospital, 51100 Reims, France.
J Pers Med. 2021 Nov 22;11(11):1238. doi: 10.3390/jpm11111238.
Background: COVID-19 may lead to refractory hypoxemia requiring venovenous extracorporeal membrane oxygenation (ECMO). Survival rate if ECMO is implemented as rescue therapy after corticosteroid failure is unknown. We aimed to investigate if ECMO implemented after failure of the full-recommended 10-day corticosteroid course can improve outcome. Methods: We conducted a three-center cohort study including consecutive dexamethasone-treated COVID-19 patients requiring ECMO between 03/2020 and 05/2021. We compared survival at hospital discharge between patients implemented after ( group) and before the end of the 10-day dexamethasone course ( group). Results: Forty patients (28M/12F; age, 57 years (51-62) (median (25th-75th percentiles)) were included, 28 (70%) in the and 12 (30%) in the group. In the group, 9/28 patients (32%) received the 6 mg/day dexamethasone regimen versus 12/12 (100%) in the group ( < 0.0001). The rest of the patients received an alternative dexamethasone regimen consisting of 20 mg/day during 5 days followed by 10 mg/day during 5 days. Patients in the group tended to be younger (57 years (51-59) versus 62 years (57-67), = 0.053). In the group, no patient (0%) survived while 12 patients (43%) survived in the group ( = 0.007). Conclusions: Survival is poor in COVID-19 patients requiring ECMO implemented after the full-recommended 10-day dexamethasone course. Since these patients may have developed a particularly severe presentation, new therapeutic strategies are urgently required.
新型冠状病毒肺炎（COVID-19）可能导致难治性低氧血症，需要采用静脉-静脉体外膜肺氧合（ECMO）治疗。在皮质类固醇治疗失败后将ECMO作为挽救疗法的生存率尚不清楚。我们旨在研究在推荐的10天皮质类固醇疗程失败后实施ECMO是否能改善预后。方法：我们进行了一项三中心队列研究，纳入了2020年3月至2021年5月期间连续接受地塞米松治疗且需要ECMO的COVID-19患者。我们比较了在10天地塞米松疗程结束后（B组）和结束前（A组）实施ECMO的患者的出院生存率。结果：共纳入40例患者（28例男性/12例女性；年龄57岁（51 - 62岁）（中位数（第25 - 75百分位数））），其中A组28例（70%），B组12例（30%）。在A组中，9/28例患者（32%）接受6毫克/天的地塞米松治疗方案，而B组为12/12例（100%）（P < 0.0001）。其余患者接受替代地塞米松治疗方案，即5天内每天20毫克，随后5天内每天10毫克。B组患者年龄往往较小（57岁（51 - 59岁） vs 62岁（57 - 67岁），P = 0.053）。在A组中，无患者（0%）存活，而B组有12例患者（43%）存活（P = 0.007）。结论：在推荐的10天地塞米松疗程后实施ECMO的COVID-19患者生存率较低。由于这些患者可能表现出特别严重的症状，迫切需要新的治疗策略。
