Department of General Surgery, Baylor University Medical Center, Dallas, Texas, USA.
Baylor Scott and White Research Institute, Dallas, Texas, USA.
J Card Surg. 2022 Oct;37(10):2972-2979. doi: 10.1111/jocs.16563. Epub 2022 Apr 30.
Adaptive mutations of the severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) virus have emerged throughout the coronavirus disease 2019 (COVID-19) pandemic. The characterization of outcomes in patients requiring extracorporeal membrane oxygenation (ECMO) for severe respiratory distress from COVID-19 during the peak prevalence of different variants is not well known.
There were 131 patients with laboratory-confirmed SARS-CoV-2 infection supported by ECMO at two referral centers within a large healthcare system. Three predominant variant phase time windows (Pre-Alpha, Alpha, and Delta) were determined by a change-point analyzer based on random population sampling and viral genome sequencing. Patient demographics and outcomes were compared.
The average age of patients was 46.9 ± 10.5 years and 70.2% (92/131) were male. Patients cannulated for ECMO during the Delta variant wave were younger compared to earlier Pre-Alpha (39.3 ± 7.8 vs. 48.0 ± 11.1 years) and Alpha phases (39.3 ± 7.8 vs. 47.2 ± 7.7 years) (p < .01). The predominantly affected race in the Pre-Alpha phase was Hispanic (52.2%; 47/90), while in Alpha (61.5%; 16/26) and Delta (40%; 6/15) variant waves, most patients were White (p < .01). Most patients received a tracheostomy (82.4%; 108/131) with a trend toward early intervention in later phases compared to Pre-Alpha (p < .01). There was no significant difference between the duration of ECMO, mechanical support, intensive care unit (ICU) length of stay (LOS), or hospital LOS over the three variant phases. The in-hospital mortality was overall 41.5% (54/131) and was also similar. Six-month survival of patients who survived to discharge was 92.2% (71/77).
There was no significant difference in survival or time on ECMO support in patients during the peak prevalence of the three variants.
严重急性呼吸综合征相关冠状病毒（SARS-CoV-2）病毒在整个 2019 年冠状病毒病（COVID-19）大流行期间已经出现了适应性突变。在不同变体流行高峰期，需要体外膜氧合（ECMO）治疗严重呼吸窘迫的 COVID-19 患者的结局特征尚不清楚。
在一个大型医疗保健系统内的两个转诊中心，有 131 名实验室确诊的 SARS-CoV-2 感染患者接受 ECMO 支持。通过基于随机人群抽样和病毒基因组测序的变点分析器确定了三个主要的变体阶段时间窗口（前 Alpha、Alpha 和 Delta）。比较了患者的人口统计学特征和结局。
患者的平均年龄为 46.9±10.5 岁，70.2%（92/131）为男性。与早期的前 Alpha （39.3±7.8 岁）和 Alpha （39.3±7.8 岁）相比，在 Delta 变体波期间接受 ECMO 插管的患者更年轻（39.3±7.8 岁）（48.0±11.1 岁）和 Alpha 阶段（39.3±7.8 岁）（47.2±7.7 岁）（p<0.01）。在前 Alpha 阶段，主要受影响的种族是西班牙裔（52.2%；47/90），而在 Alpha （61.5%；16/26）和 Delta （40%；6/15）变体波中，大多数患者是白人（p<0.01）。大多数患者接受了气管切开术（82.4%；108/131），与前 Alpha 相比，后期阶段的干预有趋势（p<0.01）。在三个变体阶段中，ECMO、机械支持、重症监护病房（ICU）住院时间（LOS）或医院 LOS 的持续时间没有显著差异。总体院内死亡率为 41.5%（54/131），相似。出院后存活患者的 6 个月生存率为 92.2%（71/77）。
在三个变体的流行高峰期，患者的生存率或 ECMO 支持时间没有显著差异。
