University of Zagreb School of Medicine, Zagreb, Croatia.
Department of Intensive Care Medicine and Neuroinfectology, University Hospital for Infectious Diseases "Dr. Fran Mihaljević," Zagreb, Croatia.
Int J Artif Organs. 2023 Apr;46(4):248-251. doi: 10.1177/03913988231163891. Epub 2023 Mar 24.
At the beginning of the COVID-19 pandemic, the role of extracorporeal membrane oxygenation (ECMO) was uncertain and the outcomes of ECMO-treated patients were unfavorable. During the pandemic, medical community realized that carefully selected patients may benefit from ECMO support. The goal of the study was to present the outcomes of ECMO-treated patients with severe COVID-19 ARDS referred to the respiratory ECMO hub in Croatia and to determine variables that influenced the outcome. Our study included all adult patients with confirmed COVID-19 ARDS that required ECMO treatment, in the period between February 2020 and April 2022. All ECMO circuits were veno-venous with femoro-jugular configuration, with drainage at the femoral site. A total of 112 adult patients with COVID-19 induced ARDS were included in the study. All patients had veno-venous ECMO treatment and 34 survived. Surviving patients were discharged home either from the hospital or from a designated rehabilitation facility. The mortality was associated with the incidence of nosocomial bacteremia, occurrence of heparin induced thrombocytopenia and acute renal failure. In order to reduce the mortality in COVID-19 ECMO patients, the treatment should be started as soon as criteria for ECMO are met. Furthermore, complications of the procedure should be detected as soon as possible. However, despite even the optimal approach, the mortality in COVID-19 ECMO patients will surpass that of non-COVID-19 ARDS ECMO patients, mostly due to poor resolving and long lasting ARDS with longer ECMO runs and ensuing infectious complications.
在 COVID-19 大流行初期，体外膜肺氧合（ECMO）的作用尚不确定，接受 ECMO 治疗的患者的预后也不理想。在大流行期间，医学界意识到精心挑选的患者可能会从 ECMO 支持中获益。本研究的目的是介绍在克罗地亚呼吸 ECMO 中心接受 ECMO 治疗的严重 COVID-19 ARDS 患者的结局，并确定影响结局的变量。我们的研究纳入了 2020 年 2 月至 2022 年 4 月期间所有需要 ECMO 治疗的确诊 COVID-19 ARDS 的成年患者。所有 ECMO 回路均为静脉-静脉型，采用股静脉-颈内静脉配置，在股部引流。共有 112 例 COVID-19 诱导的 ARDS 成年患者纳入本研究。所有患者均接受静脉-静脉 ECMO 治疗，其中 34 例存活。存活患者从医院或指定的康复设施出院回家。死亡率与医院获得性菌血症的发生率、肝素诱导的血小板减少症和急性肾功能衰竭的发生有关。为了降低 COVID-19 ECMO 患者的死亡率，一旦符合 ECMO 标准，就应开始治疗。此外，应尽快发现该程序的并发症。然而，即使采用最佳方法，COVID-19 ECMO 患者的死亡率仍将超过非 COVID-19 ARDS ECMO 患者，这主要是由于 ARDS 持续时间较长，持续时间较长的 ECMO 运行以及随之而来的感染性并发症导致的 ARDS 缓解不良和持续时间较长。
