影响 COVID-19 体外膜肺氧合患者生存的关键特征。
Key characteristics impacting survival of COVID-19 extracorporeal membrane oxygenation.
机构信息
Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Oberduerrbacherstr. 6, 97080, Würzburg, Germany.
Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Center, Kliniken Der Stadt Köln, Witten/Herdecke University Hospital, Cologne, Germany.
出版信息
Crit Care. 2022 Jun 28;26(1):190. doi: 10.1186/s13054-022-04053-6.
BACKGROUND
Severe COVID-19 induced acute respiratory distress syndrome (ARDS) often requires extracorporeal membrane oxygenation (ECMO). Recent German health insurance data revealed low ICU survival rates. Patient characteristics and experience of the ECMO center may determine intensive care unit (ICU) survival. The current study aimed to identify factors affecting ICU survival of COVID-19 ECMO patients.
METHODS
673 COVID-19 ARDS ECMO patients treated in 26 centers between January 1st 2020 and March 22nd 2021 were included. Data on clinical characteristics, adjunct therapies, complications, and outcome were documented. Block wise logistic regression analysis was applied to identify variables associated with ICU-survival.
RESULTS
Most patients were between 50 and 70 years of age. PaO/FiO ratio prior to ECMO was 72 mmHg (IQR: 58-99). ICU survival was 31.4%. Survival was significantly lower during the 2nd wave of the COVID-19 pandemic. A subgroup of 284 (42%) patients fulfilling modified EOLIA criteria had a higher survival (38%) (p = 0.0014, OR 0.64 (CI 0.41-0.99)). Survival differed between low, intermediate, and high-volume centers with 20%, 30%, and 38%, respectively (p = 0.0024). Treatment in high volume centers resulted in an odds ratio of 0.55 (CI 0.28-1.02) compared to low volume centers. Additional factors associated with survival were younger age, shorter time between intubation and ECMO initiation, BMI > 35 (compared to < 25), absence of renal replacement therapy or major bleeding/thromboembolic events.
CONCLUSIONS
Structural and patient-related factors, including age, comorbidities and ECMO case volume, determined the survival of COVID-19 ECMO. These factors combined with a more liberal ECMO indication during the 2nd wave may explain the reasonably overall low survival rate. Careful selection of patients and treatment in high volume ECMO centers was associated with higher odds of ICU survival.
TRIAL REGISTRATION
Registered in the German Clinical Trials Register (study ID: DRKS00022964, retrospectively registered, September 7th 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022964 .
背景
严重的 COVID-19 引起的急性呼吸窘迫综合征（ARDS）通常需要体外膜肺氧合（ECMO）。最近德国健康保险数据显示，重症监护病房（ICU）的生存率较低。患者特征和 ECMO 中心的经验可能决定 ICU 的生存率。本研究旨在确定影响 COVID-19 ECMO 患者 ICU 生存率的因素。
方法
2020 年 1 月 1 日至 2021 年 3 月 22 日期间，在 26 个中心治疗的 673 例 COVID-19 ARDS ECMO 患者纳入研究。记录了临床特征、辅助治疗、并发症和结果的数据。应用分块逻辑回归分析确定与 ICU 生存相关的变量。
结果
大多数患者年龄在 50-70 岁之间。ECMO 前 PaO/FiO 比值为 72mmHg（IQR：58-99）。ICU 生存率为 31.4%。在 COVID-19 大流行的第二波期间，生存率显著降低。符合改良 EOLIA 标准的 284 例（42%）患者亚组生存率较高（38%）（p=0.0014，OR 0.64（95%CI 0.41-0.99））。低、中、高容量中心之间的生存率存在差异，分别为 20%、30%和 38%（p=0.0024）。与低容量中心相比，高容量中心的治疗结果的优势比为 0.55（95%CI 0.28-1.02）。与生存相关的其他因素包括年龄较小、气管插管与 ECMO 开始之间的时间较短、BMI>35（与<25 相比）、无肾脏替代治疗或大出血/血栓栓塞事件。
结论
结构和患者相关因素，包括年龄、合并症和 ECMO 例数，决定了 COVID-19 ECMO 的生存率。这些因素与第二波期间更宽松的 ECMO 适应证相结合，可能解释了整体较低的生存率。在高容量 ECMO 中心仔细选择患者和治疗与 ICU 生存率较高相关。
试验注册
在德国临床试验注册处注册（研究 ID：DRKS00022964，回顾性注册，2020 年 9 月 7 日，https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022964）。
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