Chandel Abhimanyu, Puri Nitin, Damuth Emily, Potestio Christopher, Peterson Lars-Kristofer N, Ledane Julia, Rackley Craig R, King Christopher S, Conrad Steven A, Green Adam
Department of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, MD.
Department of Critical Care Medicine, Cooper University Health Care, Camden, NJ.
Crit Care Explor. 2023 Feb 3;5(2):e0861. doi: 10.1097/CCE.0000000000000861. eCollection 2023 Feb.
To compare complications and mortality between patients that required extracorporeal membrane oxygenation (ECMO) support for acute respiratory distress syndrome (ARDS) due to COVID-19 and non-COVID-19 viral pathogens.
Retrospective observational cohort study.
Adult patients in the Extracorporeal Life Support Organization registry.
Nine-thousand two-hundred ninety-one patients that required ECMO for viral mediated ARDS between January 2017 and December 2021.
None.
The primary outcomes of interest were mortality during ECMO support and prior to hospital discharge. Time-to-event analysis and logistic regression were used to compare outcomes between the groups. Among 9,291 included patients, 1,155 required ECMO for non-COVID-19 viral ARDS and 8,136 required ECMO for ARDS due to COVID-19. Patients with COVID-19 had longer duration of ECMO (19.6 d [interquartile range (IQR), 10.1-34.0 d] vs 10.7 d [IQR, 6.3-19.7 d]; < 0.001), higher mortality during ECMO support (44.4% vs 27.5%; < 0.001), and higher in-hospital mortality (50.2% vs 34.5%; < 0.001). Further, patients with COVID-19 were more likely to experience mechanical and clinical complications (membrane lung failure, pneumothorax, intracranial hemorrhage, and superimposed infection). After adjusting for pre-ECMO disease severity, patients with COVID-19 were more than two times as likely to die in the hospital compared with patients with non-COVID-19 viral ARDS.
Patients with COVID-19 that require ECMO have longer duration of ECMO, more complications, and higher in-hospital mortality compared with patients with non-COVID-19-related viral ARDS. Further study in patients with COVID-19 is critical to identify the patient phenotype most likely to benefit from ECMO and to better define the role of ECMO in the management of this disease process.
比较因新型冠状病毒肺炎（COVID-19）和非COVID-19病毒病原体导致急性呼吸窘迫综合征（ARDS）而需要体外膜肺氧合（ECMO）支持的患者之间的并发症和死亡率。
回顾性观察队列研究。
体外生命支持组织登记处的成年患者。
2017年1月至2021年12月期间因病毒介导的ARDS而需要ECMO的9291名患者。
无。
感兴趣的主要结局是ECMO支持期间和出院前的死亡率。采用事件发生时间分析和逻辑回归比较两组的结局。在9291名纳入患者中，1155名因非COVID-19病毒ARDS需要ECMO，8136名因COVID-19导致的ARDS需要ECMO。COVID-19患者的ECMO持续时间更长（19.6天[四分位间距（IQR），10.1 - 34.0天]对10.7天[IQR，6.3 - 19.7天]；<0.001），ECMO支持期间死亡率更高（44.4%对27.5%；<0.001），住院死亡率更高（50.2%对34.5%；<0.001）。此外，COVID-19患者更有可能出现机械和临床并发症（膜肺衰竭、气胸、颅内出血和叠加感染）。在调整ECMO前疾病严重程度后，与非COVID-19病毒ARDS患者相比，COVID-19患者在医院死亡的可能性高出两倍多。
与非COVID-19相关病毒ARDS患者相比，需要ECMO的COVID-19患者的ECMO持续时间更长，并发症更多，住院死亡率更高。对COVID-19患者进行进一步研究对于确定最有可能从ECMO中获益的患者表型以及更好地定义ECMO在该疾病过程管理中的作用至关重要。
