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需要体外膜肺氧合的新冠肺炎感染患者与未感染患者的临床结局比较

Clinical Outcome Comparison of Patients Requiring Extracorporeal Membrane Oxygenation With or Without COVID-19 Infection.

作者信息

Park Flora S, Shah Aalap C, Rao Sonali, Rinehart Joseph, Togashi Kei

机构信息

Anesthesiology and Perioperative Medicine, University of California Irvine Health, Orange, USA.

出版信息

Cureus. 2023 May 16;15(5):e39078. doi: 10.7759/cureus.39078. eCollection 2023 May.

Abstract

In severe COVID-19-related respiratory failure, extracorporeal membrane oxygenation (ECMO) is a useful modality that is used to provide effective oxygenation and ventilation to the patient. This descriptive study aimed to investigate and compare the outcomes between COVID-19-infected patients and patients who were not infected and required ECMO support. A retrospective study was undertaken on a cohort of 82 adult patients ([Formula: see text]18-year-old) who required venoarterial (VA-ECMO) and venovenous (VV-ECMO) ECMO between January 2019 and December 2022 in a single academic center. Patients who were cannulated for COVID-19-related respiratory failure (C-group) were compared to patients who were cannulated for non-COVID etiologies (non-group). Patients were excluded if data were missing regarding cannulation, decannulation, presenting diagnosis, and survival status. Categorical data were reported as counts and percentages, and continuous data were reported as means with 95% confidence intervals. Out of the 82 included ECMO patients, 33 (40.2%) were cannulated for COVID-related reasons, and 49 (59.8%) were cannulated for reasons other than COVID-19 infection. Compared to the non-group, the C-group had a higher in-hospital (75.8% vs. 55.1%) and overall mortality rate (78.8% vs. 61.2%). The C-group also had an average hospital length of stay (LOS) of 46.6 ± 13.2 days and an average intensive care unit (ICU) LOS of 44.1 ± 13.3 days. The non-group had an average hospital LOS of 24.8 ± 6.6 days and an average ICU LOS of 20.8 ± 5.9 days. Subgroup analysis of patients only treated with VV-ECMO yielded a greater in-hospital mortality rate for the C-group compared to the non-group (75.0% vs. 42.1%). COVID-19-infected patients may experience different morbidity and mortality rates as well as clinical presentations compared to non-COVID-infected patients when requiring ECMO support.

摘要

在严重的新型冠状病毒肺炎(COVID-19)相关呼吸衰竭中,体外膜肺氧合(ECMO)是一种用于为患者提供有效氧合和通气的有用方式。这项描述性研究旨在调查和比较COVID-19感染患者与未感染但需要ECMO支持的患者的预后。对2019年1月至2022年12月期间在一个学术中心需要静脉-动脉(VA-ECMO)和静脉-静脉(VV-ECMO)ECMO的82例成年患者(≥18岁)进行了一项回顾性研究。将因COVID-19相关呼吸衰竭而插管的患者(C组)与因非COVID病因插管的患者(非C组)进行比较。如果插管、拔管、现患诊断和生存状态的数据缺失,则将患者排除。分类数据以计数和百分比报告,连续数据以均值和95%置信区间报告。在82例纳入的ECMO患者中,33例(40.2%)因COVID相关原因插管,49例(59.8%)因COVID-19感染以外的原因插管。与非C组相比,C组的住院死亡率(75.8%对55.1%)和总死亡率更高(78.8%对61.2%)。C组的平均住院时间(LOS)为46.6±13.2天,平均重症监护病房(ICU)住院时间为44.1±13.3天。非C组的平均住院LOS为24.8±6.6天,平均ICU住院时间为20.8±5.9天。仅接受VV-ECMO治疗的患者亚组分析显示,C组的住院死亡率高于非C组(75.0%对42.1%)。与非COVID感染患者相比,COVID-19感染患者在需要ECMO支持时可能会经历不同的发病率、死亡率以及临床表现。

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ECMO in COVID-19 Patients: A Systematic Review and Meta-analysis.新冠肺炎患者体外膜肺氧合治疗:系统评价和荟萃分析。
J Cardiothorac Vasc Anesth. 2022 Aug;36(8 Pt A):2700-2706. doi: 10.1053/j.jvca.2021.11.006. Epub 2021 Nov 12.

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