Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Artif Organs. 2022 Nov;46(11):2257-2265. doi: 10.1111/aor.14381. Epub 2022 Aug 20.
Extracorporeal membrane oxygenation (ECMO) has shown variable results in COVID-19 pneumonia however, some evidence supports benefit. Here we compare our institution's ECMO outcomes across multiple waves of the COVID-19 pandemic.
All patients who received ECMO for COVID-19 between March 1, 2020, and March 1, 2021, were reviewed. Patients received venovenous (VV) or right ventricular assist device (RVAD/ECMO) ECMO. Early (March 1-July 6, 2020, Era 1) and late (July 7, 2020-March 1, 2021, Era 2) pandemic RVAD/ECMO patients were compared.
Fifty-four patients received ECMO of which 16 (29.6%) patients received VV ECMO and 38 (70.4%) RVAD/ECMO. Median age was 53.0 years, body mass index 36.1 kg/m , 41.2% female, and 49% Caucasian. The most common pre-cannulation treatments included steroids (79.6%) and convalescent plasma (70.4%). Median time from admission to cannulation was 7.0 days. Median support time was 30.5 days (VV ECMO 35.0 days, RVAD/ECMO 26.0 days). In- hospital mortality was 42.6% (39.5% RVAD/ECMO, 50.0% VV ECMO). Significant morbidities included infection (80.8%), bleeding events (74.5%), and renal replacement therapy (30.8%). Cumulative mortality 120-days post-cannulation was 45.7% (VV ECMO 60.8%, RVAD/ECMO 40.0%). RVAD/ECMO Era 1 demonstrated a significantly lower cumulative mortality (16.2%) compared to Era 2 (60.4%). Competing risk analysis found age (HR 0.95, [95% CI 0.92, 0.98] p = 0.005) to be a protective factor for survival.
ECMO support for COVID-19 is beneficial but carries significant morbidity. RVAD/ECMO support demonstrated consistent advantages in survival to VV-ECMO, but with declining efficacy across time during the COVID-19 pandemic.
体外膜肺氧合（ECMO）在 COVID-19 肺炎中的效果不一，但有一些证据表明其有益。在此，我们比较了我院在 COVID-19 大流行的多个波次中的 ECMO 结果。
回顾了 2020 年 3 月 1 日至 2021 年 3 月 1 日期间因 COVID-19 接受 ECMO 的所有患者。患者接受静脉-静脉（VV）或右心室辅助装置（RVAD/ECMO）ECMO。比较了大流行早期（2020 年 3 月 1 日至 7 月 6 日，时期 1）和晚期（2020 年 7 月 7 日至 2021 年 3 月 1 日，时期 2）的 RVAD/ECMO 患者。
54 例患者接受 ECMO 治疗，其中 16 例（29.6%）接受 VV ECMO，38 例（70.4%）接受 RVAD/ECMO。中位年龄为 53.0 岁，体重指数 36.1kg/m2，41.2%为女性，49%为白种人。最常见的预插管治疗包括类固醇（79.6%）和恢复期血浆（70.4%）。从入院到插管的中位时间为 7.0 天。中位支持时间为 30.5 天（VV ECMO 35.0 天，RVAD/ECMO 26.0 天）。住院死亡率为 42.6%（RVAD/ECMO 为 39.5%，VV ECMO 为 50.0%）。显著的并发症包括感染（80.8%）、出血事件（74.5%）和肾脏替代治疗（30.8%）。插管后 120 天的累积死亡率为 45.7%（VV ECMO 为 60.8%，RVAD/ECMO 为 40.0%）。RVAD/ECMO 时期 1 的累积死亡率明显低于时期 2（16.2%比 60.4%）。竞争风险分析发现年龄（HR 0.95 [95%CI 0.92，0.98]，p=0.005）是生存的保护因素。
ECMO 支持 COVID-19 是有益的，但伴有显著的发病率。与 VV-ECMO 相比，RVAD/ECMO 支持在生存率方面表现出一致的优势，但在 COVID-19 大流行期间随时间推移疗效下降。
