桥接静脉-静脉体外膜肺氧合对新型冠状病毒肺炎肺移植的影响
Impact of bridging veno-venous extracorporeal membrane oxygenation to COVID-19 lung transplantation.
作者信息
Toyoda Takahide, Thomae Benjamin Louis, Kaiho Taisuke, Cerier Emily Jeong, Tomic Rade, Budinger G R Scott, Bharat Ankit, Kurihara Chitaru
机构信息
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
出版信息
J Thorac Dis. 2024 Jul 30;16(7):4417-4428. doi: 10.21037/jtd-24-132. Epub 2024 Jul 26.
BACKGROUND
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) therapy is being increasingly used as respiratory support for patients with severe coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS). However, the long-term outcome of VV-ECMO as a bridge to lung transplantation in COVID-19-associated ARDS remains unclear, hence the purpose of this study aimed to evaluate its long-term outcome, safety, and feasibility.
METHODS
This was a retrospective cohort study from an institutional lung transplantation database between June 2020 and June 2022. Data on demographics, pre-transplantation laboratory values, postoperative outcomes, preoperative and postoperative transthoracic echocardiography findings, and survival rates were collected. Chi-square, Mann-Whitney U, Student's t, Kaplan-Meier, and Wilcoxon signed-rank tests were used for analysis.
RESULTS
Twenty-five patients with COVID-19-associated ARDS underwent lung transplant surgery with VV-ECMO bridge. Unfortunately, six patients with COVID-19-associated ARDS using VV-ECMO died while waiting for transplantation during the same study period. Patients with VV-ECMO bridge were a more severe cohort than 16 patients without VV-ECMO bridge (lung allocation score: 88.1 74.9, P<0.001). These patients had longer intensive care unit and hospital stays (P=0.03 and P=0.02, respectively) and a higher incidence of complications after lung transplantation. The one-year survival rate of patients with VV-ECMO bridge was lower than that of patients without (78.3% 100.0%, P=0.06), but comparable to that of patients with other lung transplant indications (84.2%, P=0.95). Echocardiography showed a decrease in the right ventricular systolic pressure (P=0.01), confirming that lung transplantation improved right heart function.
CONCLUSIONS
Our findings suggest that VV-ECMO can be used to safely bridge patients with COVID-19 associated ARDS with right heart failure.
背景
静脉-静脉体外膜肺氧合（VV-ECMO）治疗正越来越多地被用作严重2019冠状病毒病（COVID-19）相关急性呼吸窘迫综合征（ARDS）患者的呼吸支持。然而，VV-ECMO作为COVID-19相关ARDS患者肺移植桥梁的长期结局仍不清楚，因此本研究旨在评估其长期结局、安全性和可行性。
方法
这是一项对2020年6月至2022年6月机构肺移植数据库进行的回顾性队列研究。收集了人口统计学数据、移植前实验室检查值、术后结局、术前和术后经胸超声心动图检查结果以及生存率。采用卡方检验、曼-惠特尼U检验、学生t检验、Kaplan-Meier检验和Wilcoxon符号秩检验进行分析。
结果
25例COVID-19相关ARDS患者接受了VV-ECMO桥接的肺移植手术。不幸的是，在同一研究期间，6例使用VV-ECMO的COVID-19相关ARDS患者在等待移植期间死亡。接受VV-ECMO桥接的患者比16例未接受VV-ECMO桥接的患者病情更严重（肺分配评分：88.1对74.9，P<0.001）。这些患者在重症监护病房和医院的住院时间更长（分别为P=0.03和P=0.02），肺移植后并发症发生率更高。接受VV-ECMO桥接的患者的一年生存率低于未接受桥接的患者（78.3%对100.0%，P=0.06），但与其他肺移植适应证患者的生存率相当（84.2%，P=0.
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