From the Medical Intensive Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
General Intensive Care Unit, Sheba Medical Center, Ramat-Gan, Israel.
ASAIO J. 2023 Aug 1;69(8):e363-e367. doi: 10.1097/MAT.0000000000001996. Epub 2023 Jul 29.
In this retrospective multicenter observational study, we describe the Israeli experience with veno-venous extracorporeal membrane oxygenation (VV ECMO) for the treatment of COVID-19-induced severe adult respiratory distress syndrome (ARDS), in which ECMO cannulation was done while the patients were awake and spontaneously breathing without endotracheal tube, namely "awake ECMO." We enrolled all adult patients with severe ARDS due to COVID-19, treated with VV ECMO between March 1, 2020, and November 30, 2021, in which cannulation was done while the patient was awake and spontaneously breathing. During the study period, 365 COVID-19 ARDS patients were treated with VV ECMO. Of these, 25 (6.8%) were treated as awake ECMO. The patient's mean age was 52 years, and 80% were male. Nine of the 25 patients (36%) remained awake throughout their intensive care unit stay and were not sedated and mechanically ventilated at all. Sixteen (64%) were eventually intubated while being on ECMO. Six months survival was 76%. Median mechanical ventilation-free days on ECMO was 8 (interquartile range 5-12) days. This hypothesis-generating study suggests that treating COVID-19 ARDS patients with VV ECMO without sedation and mechanical ventilation is feasible, yet, additional research will be required in order to determine if this modality offers a survival benefit and to identify who are the patients most likely to benefit from it.
在这项回顾性多中心观察性研究中，我们描述了以色列在使用静脉-静脉体外膜肺氧合（VV ECMO）治疗 COVID-19 引起的成人严重呼吸窘迫综合征（ARDS）方面的经验，其中 ECMO 插管是在患者清醒且自主呼吸而无需气管插管的情况下进行的，即“清醒 ECMO”。我们招募了所有因 COVID-19 导致严重 ARDS 而接受 VV ECMO 治疗的成年患者，这些患者在 2020 年 3 月 1 日至 2021 年 11 月 30 日期间接受了清醒 ECMO 治疗。在研究期间，365 例 COVID-19 ARDS 患者接受了 VV ECMO 治疗。其中，25 例（6.8%）接受了清醒 ECMO 治疗。患者的平均年龄为 52 岁，80%为男性。25 例患者中有 9 例（36%）在整个重症监护病房期间保持清醒，完全没有镇静和机械通气。16 例（64%）最终在接受 ECMO 治疗时被插管。6 个月生存率为 76%。在 ECMO 上无机械通气天数的中位数为 8 天（四分位距 5-12 天）。这项初步研究表明，对 COVID-19 ARDS 患者进行无镇静和机械通气的 VV ECMO 治疗是可行的，但需要进一步研究，以确定这种方法是否能提供生存获益，并确定哪些患者最有可能从中获益。
