Department of Hospital Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
J Cardiothorac Vasc Anesth. 2022 Aug;36(8 Pt B):2935-2941. doi: 10.1053/j.jvca.2022.01.049. Epub 2022 Feb 4.
Cardiac injury has been reported in up to 20%-to-30% of patients with COVID-19, and severe disease can lead to cardiopulmonary failure. The role of mechanical circulatory support in these patients remains undetermined. The authors here aimed to determine the characteristics and outcomes of patients with COVID-19 requiring venoarterial extracorporeal membrane oxygenation (VA ECMO) or veno-arterial-venous (VAV) ECMO support.
A multicenter, retrospective case series.
The cohort consisted of adult patients (18 years of age and older) with confirmed COVID-19 requiring VA ECMO or VAV ECMO support in the period from March 1, 2020, to April 30, 2021. Outcomes were recorded until July 31, 2021.
To show factors related to death during hospitalization, patients were grouped as survivors and nonsurvivors. Kaplan-Meier analysis was used to estimate 90-day in-hospital mortality. Overall, 37 patients from 12 centers comprised the study cohort. The median patient age was 44 years old (interquartile range [IQR], 35-52), and 12 (32%) were female patients. The duration of ECMO support ranged from 2-to-132 days. At the end of the follow-up period, 13 patients (35%) were discharged or transferred alive, and 24 patients (65%) died during the hospitalization. The cumulative in-hospital mortality at 90 days was 64% (95% confidence interval: 47-81). During the time from intubation to VA ECMO or VAV ECMO initiation (1 day [IQR 0-7.5] v 6 days [IQR 2.5-14], p = 0.0383), body mass index (32 [IQR 26-36] v 37 [IQR 33-40], p = 0.009), and baseline C-reactive protein (7.15 v 38.9 mg/dL, p = 0.009) were higher in those who expired.
Only one-third of the patients with COVID-19 requiring VA ECMO or VAV ECMO survived to discharge. Close monitoring of at-risk patients with early initiation of ECMO with circulatory support may further improve outcomes.
据报道，多达 20%-30%的 COVID-19 患者存在心脏损伤，重症患者可导致心肺衰竭。机械循环支持在这些患者中的作用仍未确定。作者旨在确定需要静脉动脉体外膜肺氧合（VA ECMO）或静脉-动脉-静脉（VAV）ECMO 支持的 COVID-19 患者的特征和结局。
多中心回顾性病例系列。
该队列包括 2020 年 3 月 1 日至 2021 年 4 月 30 日期间接受 VA ECMO 或 VAV ECMO 支持的确诊 COVID-19 成年患者（年龄 18 岁及以上）。记录结局直至 2021 年 7 月 31 日。
为了显示住院期间与死亡相关的因素，将患者分为存活组和非存活组。采用 Kaplan-Meier 分析估计 90 天院内死亡率。总体而言，该研究队列包括来自 12 个中心的 37 名患者。患者中位年龄为 44 岁（四分位距[IQR]，35-52），12 名（32%）为女性患者。ECMO 支持时间为 2-132 天。随访结束时，13 名（35%）患者出院或存活转移，24 名（65%）患者住院期间死亡。90 天内累计住院死亡率为 64%（95%置信区间：47-81）。从插管到 VA ECMO 或 VAV ECMO 启动的时间（1 天[IQR 0-7.5]比 6 天[IQR 2.5-14]，p=0.0383）、体重指数（32[IQR 26-36]比 37[IQR 33-40]，p=0.009）和基线 C 反应蛋白（7.15 比 38.9mg/dL，p=0.009）在死亡患者中更高。
仅三分之一的 COVID-19 患者需要 VA ECMO 或 VAV ECMO 存活出院。密切监测高危患者并尽早开始循环支持的 ECMO 可能会进一步改善结局。
