Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York.
Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York.
Ann Thorac Surg. 2022 Jul;114(1):70-75. doi: 10.1016/j.athoracsur.2022.01.003. Epub 2022 Mar 10.
Severe coronavirus disease 2019 (COVID-19) can cause acute respiratory failure requiring mechanical ventilation. Venovenous (VV) extracorporeal membrane oxygenation (ECMO) has been used in patients in whom conventional mechanical ventilatory support has failed. To date, published data have focused on survival from ECMO and survival to discharge. In addition to survival to discharge, this study reports 1-year follow-up data for patients who were successfully discharged from the hospital.
A single-institution, retrospective review of all patients with severe COVID-19 who were cannulated for VV-ECMO between March 10, 2020 and May 1, 2020 was performed. A multidisciplinary ECMO team evaluated, selected, and managed patients with ECMO support. The primary outcome of this study was survival to discharge. Available 1-year follow-up data are also reported.
A total of 30 patients were supported with VV-ECMO, and 27 patients (90%) survived to discharge. All patients were discharged home or to acute rehabilitation on room air, except for 1 patient (3.7%), who required supplemental oxygen therapy. At a median follow-up of 10.8 months (interquartile range [IQR], 8.9-14.4 months) since ECMO cannulation, survival was 86.7%, including 1 patient who underwent lung transplantation. Of the patients discharged from the hospital, 44.4% (12/27) had pulmonary function testing, with a median percent predicted forced expiratory volume of 100% (IQR, 91%-110%). For survivors, a 6-minute walk test was performed in 59.3% (16/27), with a median value of 350 m (IQR, 286-379 m).
A well-defined patient selection and management strategy of VV-ECMO support in patients with severe COVID-19 resulted in exceptional survival to discharge that was sustained at 1-year after ECMO cannulation.
严重的 2019 年冠状病毒病（COVID-19）可导致需要机械通气的急性呼吸衰竭。静脉-静脉（VV）体外膜肺氧合（ECMO）已用于常规机械通气支持失败的患者。迄今为止，已发表的数据集中在 ECMO 存活率和出院存活率上。除了出院存活率外，本研究还报告了成功从医院出院的患者的 1 年随访数据。
对 2020 年 3 月 10 日至 2020 年 5 月 1 日期间因 VV-ECMO 插管的所有严重 COVID-19 患者进行了单中心回顾性研究。一个多学科的 ECMO 团队评估、选择和管理 ECMO 支持的患者。本研究的主要结局是出院存活率。还报告了可用的 1 年随访数据。
共 30 例患者接受 VV-ECMO 支持，27 例（90%）患者存活至出院。除 1 例（3.7%）患者需要补充氧疗外，所有患者均出院回家或在室内空气下进行急性康复。在 ECMO 插管后的中位随访 10.8 个月（四分位距 [IQR]，8.9-14.4 个月），存活率为 86.7%，包括 1 例接受肺移植的患者。在出院的患者中，44.4%（12/27）进行了肺功能测试，中位预测用力呼气量百分比为 100%（IQR，91%-110%）。对于幸存者，59.3%（16/27）进行了 6 分钟步行测试，中位值为 350m（IQR，286-379m）。
在严重 COVID-19 患者中，明确的患者选择和 VV-ECMO 支持管理策略导致了异常高的出院存活率，并且在 ECMO 插管后 1 年仍然持续。
