Nogueira Joana, Freitas Ricardo, Sousa José Eduardo, Santos Luís Linhares
Intensive Care Medicine, Coimbra University Hospital Centre, Coimbra, Portugal.
J Anesth Analg Crit Care. 2024 Aug 13;4(1):55. doi: 10.1186/s44158-024-00191-1.
Obesity causes significant difficulties in successful extracorporeal membrane oxygenation (ECMO) support and may interfere with patient outcomes. During the COVID-19 pandemic, we experienced an increased number of obese patients supported with ECMO in our intensive care unit due to severe illness in this population.
We designed a single-center retrospective study to identify prognostic factors for 180-day survival in obese critical COVID-19 patients receiving venovenous ECMO (VV-ECMO). We included adult critical COVID-19 patients on VV-ECMO, who were obese and overweight (according to the World Health Organization) and admitted to a tertiary hospital's intensive care unit from April 1, 2020, to May 31, 2022. Univariate logistic regression analysis was performed to assess differences in 180-day mortality.
Forty-one patients were included. The median age was 55 (IQR 45-60) years, and 70.7% of the patients were male. The median body mass index (BMI) was 36 (IQR 31-42.5) kg/m; 39% of patients had a BMI ≥ 40 kg/m. The participants had 3 (IQR 1.5-4) days of mechanical ventilation prior to ECMO, and 63.4% were weaned from VV-ECMO support after a median of 19 (IQR 10-34) days. The median ICU length of stay was 31.9 (IQR 17.5-44.5) days. The duration of mechanical ventilation was 30 (IQR 19-49.5) days. The 180-day mortality rate was 41.5%. Univariate logistic regression analysis revealed that a higher BMI was associated with greater 180-day survival (OR 1.157 [1.038-1.291], p = 0.009). Younger age, female sex, less invasive ventilation time before ECMO, and fewer complications at the time of ECMO cannulation were associated with greater 180-day survival [OR 0.858 (0.774-0.953), p 0.004; OR 0.074 (0.008-0.650), p 0.019; OR 0.612 (0.401-0.933), p 0.022; OR 0.13 (0.03-0.740), p 0.022), respectively].
In this retrospective cohort of critical COVID-19 obese adult patients supported by VV-ECMO, a higher BMI, younger age, and female sex were associated with greater 180-day survival. A shorter invasive ventilation time before ECMO and fewer complications at ECMO cannulation were also associated with increased survival.
肥胖给体外膜肺氧合（ECMO）的成功支持带来了重大困难，并可能影响患者的预后。在新冠疫情期间，我们重症监护病房中接受ECMO支持的肥胖患者数量因该人群的严重疾病而增加。
我们设计了一项单中心回顾性研究，以确定接受静脉-静脉ECMO（VV-ECMO）的肥胖重症新冠患者180天生存的预后因素。我们纳入了2020年4月1日至2022年5月31日期间在一家三级医院重症监护病房接受VV-ECMO治疗的肥胖和超重（根据世界卫生组织标准）的成年重症新冠患者。进行单因素逻辑回归分析以评估180天死亡率的差异。
共纳入41例患者。中位年龄为55岁（四分位间距45 - 60岁），70.7%的患者为男性。中位体重指数（BMI）为36（四分位间距31 - 42.5）kg/m²；39%的患者BMI≥40 kg/m²。参与者在接受ECMO之前接受了3天（四分位间距1.5 - 4天）的机械通气，63.4%的患者在中位19天（四分位间距10 - 34天）后脱离VV-ECMO支持。中位重症监护病房住院时间为31.9天（四分位间距17.5 - 44.5天）。机械通气时间为30天（四分位间距19 - 49.5天）。180天死亡率为41.5%。单因素逻辑回归分析显示，较高的BMI与更高的180天生存率相关（比值比1.157 [1.038 - 1.291]，p = 0.009）。年龄较小、女性、ECMO前有创通气时间较短以及ECMO插管时并发症较少与更高的180天生存率相关[比值比分别为0.858（0.774 - 0.953），p = 0.004；0.074（0.008 - 0.650），p = 0.019；0.612（0.401 - 0.933），p = 0.022；0.13（0.03 - 0.740），p = 0.022]。
在这个接受VV-ECMO支持的重症新冠肥胖成年患者回顾性队列中，较高的BMI、较年轻的年龄和女性与更高的180天生存率相关。ECMO前较短的有创通气时间和ECMO插管时较少的并发症也与生存率增加相关。
