Muenster Stefan, Schumacher Silvia, Schmandt Mathias, Kreyer Stefan, Poth Jens Martin, Putensen Christian, Schewe Jens-Christian, Ehrentraut Stefan Felix
Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany.
Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Rostock, 18057 Rostock, Germany.
J Clin Med. 2024 Sep 12;13(18):5391. doi: 10.3390/jcm13185391.
(1) The COVID-19 pandemic presented significant challenges in managing acute respiratory distress syndrome (ARDS), with extracorporeal membrane oxygenation (ECMO) being a critical but resource-intensive intervention. (2) This retrospective study analyzed veno-venous (VV) ECMO therapy in ARDS patients before and during the pandemic at a high-volume ECMO center in Germany. The study used a reduced ECMO team (one medical and one nursing specialist) to optimize patient care with limited resources, aiming to offer insights for future pandemic management. Data from 181 adult patients (age ≥ 18) with severe ARDS were analyzed: 57 pre-pandemic and 124 during the pandemic. (3) Despite increased isolation measures during the pandemic (25% pre-COVID-19 vs. 79% during COVID-19, < 0.0001), there was no significant change in transportation mode (ground vs. air) or ECMO implantation times at local hospitals. Similarly, time and distance for primary ECMO transport remained unchanged between the two periods. Complication rates related to ECMO circuit placement and prolonged transport were also insignificant across groups. However, ECMO therapy duration (median 12 days pre-COVID-19 vs. 19 days during COVID-19, < 0.0001) and hospital stays (median 3 days pre-COVID-19 vs. 7 days during COVID-19, < 0.01) were longer during the pandemic. Mortality rates were also higher during the pandemic (49% pre-COVID-19 vs. 65% during COVID-19, < 0.05). (4) In conclusion, a reduced ECMO team proved to be an effective resource-saving strategy that maintained high-quality care with low complication rates, despite the additional challenges posed by pandemic-related isolation measures.
(1) 新型冠状病毒肺炎（COVID-19）大流行给急性呼吸窘迫综合征（ARDS）的管理带来了重大挑战，体外膜肺氧合（ECMO）是一种关键但资源密集型的干预措施。(2) 这项回顾性研究分析了德国一家大容量ECMO中心在大流行之前和期间对ARDS患者进行的静脉 - 静脉（VV）ECMO治疗。该研究使用了精简的ECMO团队（一名医学专家和一名护理专家），以在资源有限的情况下优化患者护理，旨在为未来的大流行管理提供见解。分析了181例成年重症ARDS患者（年龄≥18岁）的数据：57例在大流行之前，124例在大流行期间。(3) 尽管在大流行期间隔离措施有所增加（COVID-19之前为25%，COVID-19期间为79%，<0.0001），但转运方式（地面与空中）或当地医院的ECMO植入时间没有显著变化。同样，两个时期之间主要ECMO转运的时间和距离保持不变。不同组之间与ECMO回路放置和长时间转运相关的并发症发生率也无显著差异。然而，大流行期间ECMO治疗持续时间（COVID-19之前中位数为12天，COVID-19期间为19天，<0.0001）和住院时间（COVID-19之前中位数为3天，COVID-19期间为7天，<0.01）更长。大流行期间的死亡率也更高（COVID-19之前为49%，COVID-19期间为65%，<0.05）。(4) 总之，尽管大流行相关隔离措施带来了额外挑战，但精简的ECMO团队被证明是一种有效的资源节约策略，能够以低并发症发生率维持高质量护理。
