体外膜肺氧合治疗 COVID-19 和 H1N1 流感相关急性呼吸窘迫综合征：一项多中心回顾性队列研究。

Extracorporeal membrane oxygenation for COVID-19 and influenza H1N1 associated acute respiratory distress syndrome: a multicenter retrospective cohort study.

机构信息

Department of Surgical Sciences, University of Turin, Turin, Italy.

Department of Anaesthesia, Critical Care and Emergency - Città Della Salute E Della Scienza Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.

出版信息

Crit Care. 2022 Feb 5;26(1):34. doi: 10.1186/s13054-022-03906-4.

DOI:10.1186/s13054-022-03906-4

PMID:35123562

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8817653/

Abstract

BACKGROUND

Extracorporeal membrane oxygenation (ECMO) has become an established rescue therapy for severe acute respiratory distress syndrome (ARDS) in several etiologies including influenza A H1N1 pneumonia. The benefit of receiving ECMO in coronavirus disease 2019 (COVID-19) is still uncertain. The aim of this analysis was to compare the outcome of patients who received veno-venous ECMO for COVID-19 and Influenza A H1N1 associated ARDS.

METHODS

This was a multicenter retrospective cohort study including adults with ARDS, receiving ECMO for COVID-19 and influenza A H1N1 pneumonia between 2009 and 2021 in seven Italian ICU. The primary outcome was any-cause mortality at 60 days after ECMO initiation. We used a multivariable Cox model to estimate the difference in mortality accounting for patients' characteristics and treatment factors before ECMO was started. Secondary outcomes were mortality at 90 days, ICU and hospital length of stay and ECMO associated complications.

RESULTS

Data from 308 patients with COVID-19 (N = 146) and H1N1 (N = 162) associated ARDS who had received ECMO support were included. The estimated cumulative mortality at 60 days after initiating ECMO was higher in COVID-19 (46%) than H1N1 (27%) patients (hazard ratio 1.76, 95% CI 1.17-2.46). When adjusting for confounders, specifically age and hospital length of stay before ECMO support, the hazard ratio decreased to 1.39, 95% CI 0.78-2.47. ICU and hospital length of stay, duration of ECMO and invasive mechanical ventilation and ECMO-associated hemorrhagic complications were higher in COVID-19 than H1N1 patients.

CONCLUSION

In patients with ARDS who received ECMO, the observed unadjusted 60-day mortality was higher in cases of COVID-19 than H1N1 pneumonia. This difference in mortality was not significant after multivariable adjustment; older age and longer hospital length of stay before ECMO emerged as important covariates that could explain the observed difference.

TRIAL REGISTRATION NUMBER

NCT05080933 , retrospectively registered.

摘要

背景

体外膜肺氧合（ECMO）已成为治疗多种病因所致严重急性呼吸窘迫综合征（ARDS）的一种成熟的抢救治疗手段，包括甲型 H1N1 流感肺炎。在 2019 冠状病毒病（COVID-19）中接受 ECMO 的益处尚不确定。本分析的目的是比较因 COVID-19 和甲型 H1N1 相关 ARDS 而接受静脉-静脉 ECMO 治疗的患者的结局。

方法

这是一项多中心回顾性队列研究，纳入了 2009 年至 2021 年间在意大利七家 ICU 中因 COVID-19 和甲型 H1N1 肺炎而接受 ECMO 治疗的 ARDS 成人患者。主要结局为 ECMO 开始后 60 天的全因死亡率。我们使用多变量 Cox 模型来估计死亡率的差异，考虑 ECMO 开始前患者的特征和治疗因素。次要结局为 90 天死亡率、ICU 和住院时间以及 ECMO 相关并发症。

结果

纳入了 308 例 COVID-19（N=146）和 H1N1（N=162）相关 ARDS 患者，这些患者接受了 ECMO 支持。COVID-19 患者在 ECMO 开始后 60 天的估计累积死亡率（46%）高于 H1N1 患者（27%）（风险比 1.76，95%CI 1.17-2.46）。当调整混杂因素，特别是 ECMO 支持前的年龄和住院时间后，风险比降低至 1.39，95%CI 0.78-2.47。COVID-19 患者的 ICU 和住院时间、ECMO 和有创机械通气时间以及 ECMO 相关出血性并发症均高于 H1N1 患者。