体外膜肺氧合对 COVID-19 急性呼吸窘迫综合征的生理益处：单中心经验。

Physiologic benefits of veno-pulmonary extracorporeal membrane oxygenation for COVID-19 ARDS: A single center experience.

机构信息

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA.

Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA.

出版信息

Int J Artif Organs. 2024 Mar;47(3):181-189. doi: 10.1177/03913988241234543. Epub 2024 Feb 28.

DOI:10.1177/03913988241234543

PMID:38418945

Abstract

BACKGROUND

A subset of patients with COVID-19 acute respiratory distress syndrome (ARDS) require extracorporeal membrane oxygenation (ECMO). Veno-pulmonary (VP) ECMO provides support to the right ventricle and decreased risk of recirculation.

METHODS

A retrospective analysis of patients with COVID-19 ARDS and VP ECMO was performed. Patients were separated into groups by indication (1) "right ventricular (RV) failure," (2) "refractory hypoxemia," and (3) "recurrent suck-down events (SDEs)." Pre- and post-configuration vasoactive inotropic scores (VIS), fraction of inspired oxygen (FIO), and resolution of SDEs were reported. A 90-day mortality was computed for all groups. Patients were also compared to those who underwent conventional venovenous (VV) ECMO.

RESULTS

Forty-seven patients underwent VP ECMO configuration, 18 in group 1, 16 in group 2, and 8 in group 3. Ninety-day mortality was 66% for the entire cohort and was 77.8%, 81.3% and 37.5% for groups 1, 2, and 3, respectively. Mean VIS decreased in group 1 (8.3 vs 2.9, = 0.005), while mean FIO decreased in the group 2 and was sustained at 72 h (82.5% vs 52.5% and 47.5%, < 0.001). Six of the eight (75%) of patients with recurrent SDEs had resolution of these events after configuration to VP ECMO. Patients with VP ECMO spent more days on ECMO (33 days compared to 18 days, = 0.004) with no difference in mortality (66% compared to 55.1%, = 0.28).

CONCLUSION

VP ECMO in COVID-19 ARDS improves hemodynamics in patients with RV failure, improves oxygenation in patients with refractory hypoxemia and improves the frequency of SDEs.

摘要

背景

一部分 COVID-19 急性呼吸窘迫综合征（ARDS）患者需要体外膜肺氧合（ECMO）治疗。静脉-肺（VP）ECMO 为右心室提供支持，降低再循环风险。

方法

对接受 COVID-19 ARDS 与 VP ECMO 治疗的患者进行回顾性分析。根据适应证将患者分为三组：（1）“右心室（RV）衰竭”；（2）“难治性低氧血症”；（3）“反复抽吸事件（SDE）”。报告患者在配置 VP ECMO 前后的血管活性正性肌力药评分（VIS）、吸入氧分数（FIO）和 SDE 缓解情况。计算所有组别的 90 天死亡率。还将患者与接受常规静脉-静脉（VV）ECMO 的患者进行了比较。

结果

47 例患者接受了 VP ECMO 配置，其中 18 例在第 1 组，16 例在第 2 组，8 例在第 3 组。整个队列的 90 天死亡率为 66%，第 1、2 和 3 组的死亡率分别为 77.8%、81.3%和 37.5%。第 1 组的平均 VIS 下降（8.3 降至 2.9，=0.005），而第 2 组的平均 FIO 下降，并在 72 小时内持续（82.5%降至 52.5%和 47.5%，<0.001）。8 例反复发生 SDE 的患者中有 6 例在转为 VP ECMO 后这些事件得到缓解。接受 VP ECMO 的患者在 ECMO 上花费的天数更多（33 天比 18 天，=0.004），死亡率无差异（66%比 55.1%，=0.28）。