Hettlich Vincent, Immohr Moritz B, Brandenburger Timo, Kindgen-Milles Detlef, Feldt Torsten, Akhyari Payam, Tudorache Igor, Aubin Hug, Dalyanoglu Hannan, Lichtenberg Artur, Boeken Udo
Klinik für Herzchirurgie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland.
Klinik für Anästhesiologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.
Z Herz Thorax Gefasschir. 2022;36(5):323-327. doi: 10.1007/s00398-022-00528-4. Epub 2022 Jul 19.
Since the beginning of the COVID-19 pandemic global health systems are confronted with a large number of unknown problems. Venovenous (vv) extracorporeal membrane oxygenation (ECMO) in cases of therapy refractive ARDS often represents a last resort treatment. To improve the health care it is necessary to identify possible influencing factors.
This analysis presents the findings of an ECMO centre and aims to identify potential factors with an impact on vv-ECMO therapy in cases of COVID-19.
Between 03/2020 and 01/2022 = 96 patients were treated with vv-ECMO in cases of a COVID-19 infection in our center. A retrospective analysis of demographic and health-specific data took place. The patients with fatal treatment outcome (L-group, = 62) were compared to the surviving patients (Ü-group, = 34).
Overall = 34 (35%) of the patients survived the hospital stay. The patients with a fatal treatment outcome had an average age of 56.7 ± 9.5 years compared to the average age of the surviving patients of 47.9 ± 12.9 years. There were = 72 (75%) males and = 24 (25%) females among the treated patients, = 51 (82.3%) of the deceased patients were male and = 11 (17.7%) were female. The prevalence of pre-existing illnesses like COPD, diabetes mellitus, cardiovascular diseases and chronic renal insufficiency had shown no significant difference between both groups. Also, in relation to the presence of arterial hypertension and obesity we could not prove a negative influence on the treatment outcome. A nicotine abuse in the patient history showed a negative tendency. The most common reasons for the death of patients were respiratory failure, neurological injury, multiorgan failure and sepsis.
The use of vv-ECMO in cases of therapy resistant ARDS in COVID-19 still correlates with a high mortality and as such should only be considered as a last resort of intensive care treatment.According to our expectations we could notice better therapy results for younger patients as well as for women in our patient database. In addition, for most comorbidities we could not prove any negative influence on the therapy outcome. This knowledge could help to identify future high-risk patients.
自新冠疫情开始以来，全球卫生系统面临着大量未知问题。对于治疗无效的急性呼吸窘迫综合征（ARDS）患者，静脉-静脉（vv）体外膜肺氧合（ECMO）往往是最后的治疗手段。为改善医疗保健，有必要确定可能的影响因素。
本分析展示了一个ECMO中心的研究结果，旨在确定对新冠患者vv-ECMO治疗有影响的潜在因素。
2020年3月至2022年1月期间，我们中心有96例新冠感染患者接受了vv-ECMO治疗。对人口统计学和健康相关数据进行了回顾性分析。将治疗结果为死亡的患者（L组，n = 62）与存活患者（Ü组，n = 34）进行比较。
总体而言，34例（35%）患者存活出院。治疗结果为死亡的患者平均年龄为56.7±9.5岁，而存活患者的平均年龄为47.9±12.9岁。接受治疗的患者中男性有72例（75%），女性有24例（25%），死亡患者中有51例（82.3%）为男性，11例（17.7%）为女性。慢性阻塞性肺疾病（COPD）、糖尿病、心血管疾病和慢性肾功能不全等既往疾病的患病率在两组之间无显著差异。此外，关于动脉高血压和肥胖的存在情况，我们无法证明其对治疗结果有负面影响。患者病史中有尼古丁滥用情况显示出负面倾向。患者死亡的最常见原因是呼吸衰竭、神经损伤、多器官功能衰竭和败血症。
在新冠治疗抵抗性ARDS病例中使用vv-ECMO仍然与高死亡率相关，因此应仅被视为重症监护治疗的最后手段。根据我们的预期，我们在患者数据库中注意到年轻患者和女性的治疗效果更好。此外，对于大多数合并症，我们无法证明其对治疗结果有任何负面影响。这些知识有助于识别未来的高危患者。
