治疗性血浆置换疗法对重症 COVID-19 急性呼吸窘迫综合征患者静脉-静脉体外膜肺氧合脱机成功的影响。

The effect of therapeutic plasma exchange therapy on veno-venous ECMO weaning success in severe COVID-19 ARDS patients.

机构信息

University of Health Sciences Bakırköy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey.

出版信息

Ther Apher Dial. 2023 Aug;27(4):780-789. doi: 10.1111/1744-9987.13979. Epub 2023 Mar 16.

DOI:10.1111/1744-9987.13979

PMID:36862373

Abstract

INTRODUCTION

Primarily, this study aimed to investigate the effect of TPE (therapeutic plasma exchange) treatment on successful ECMO weaning in severe COVID-19 ARDS patients treated with V-V ECMO.

METHODS

The study was applied retrospectively on patients over the age of 18 who were hospitalized in the ICU between January 1, 2020 and March 1, 2022.

RESULTS

The study was performed on 33 patients, 36.3% (n: 12) of whom received TPE treatment. The rate of successful ECMO weaning was statistically higher in the TPE treatment group (without TPE: 14.3% [n: 3], with TPE: 50% [n: 6], p = 0.044). The 1-month mortality was also statistically lower in the TPE treatment group (p = 0.044). In the logistic analysis, It was found that the risk of unsuccessful ECMO weaning increased 6 times in those who did not receive TPE treatment (OR; 6.0, 95% CI; 1.134-31.735, p = 0.035).

CONCLUSION

TPE treatment may increase the success rate of V-V ECMO weaning in severe COVID-19 ARDS patients treated with V-V ECMO.

摘要

介绍

本研究主要旨在探讨在接受 V-V ECMO 治疗的严重 COVID-19 ARDS 患者中，TPE（治疗性血浆置换）治疗对 ECMO 成功撤机的影响。

方法

本研究回顾性应用于 2020 年 1 月 1 日至 2022 年 3 月 1 日期间在 ICU 住院的年龄在 18 岁以上的患者。

结果

本研究共纳入 33 名患者，其中 36.3%（n：12）接受了 TPE 治疗。TPE 治疗组 ECMO 撤机成功率明显更高（无 TPE：14.3%[n：3]，有 TPE：50%[n：6]，p=0.044）。TPE 治疗组 1 个月死亡率也明显更低（p=0.044）。在逻辑回归分析中，发现未接受 TPE 治疗的患者 ECMO 撤机失败的风险增加了 6 倍（OR；6.0，95%CI；1.134-31.735，p=0.035）。