静脉-静脉体外膜肺氧合治疗严重 COVID-19 相关急性呼吸窘迫综合征：一项回顾性、全国性、丹麦队列研究。
Veno-venous extracorporeal membrane oxygenation for severe COVID-19 associated acute respiratory distress syndrome: A retrospective, nationwide, Danish cohort study.
机构信息
Department of Cardiothoracic Anaesthesia and Intensive Care, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
Department of Anaesthesiology and Intensive Care, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
出版信息
Acta Anaesthesiol Scand. 2025 Jan;69(1):e14522. doi: 10.1111/aas.14522. Epub 2024 Oct 22.
BACKGROUND
Severe acute respiratory syndrome (ARDS) may require veno-venous extracorporeal membrane oxygenation (V-V ECMO). The aim of this study was to provide data on patient selection and outcome in a nationwide cohort study of patients with COVID-19 associated ARDS supported with V-V ECMO.
METHODS
We identified all patients with COVID-19, who were supported with V-V ECMO in Denmark from March 10, 2020, to December 31, 2021, and retrieved data on patients who were referred to- and accepted for ECMO, demographics, outcome data, and complications. Risk factors for mortality were analysed using multivariate Cox regression analysis.
RESULTS
During the study period, 1836 patients were admitted to Danish intensive care units (ICUs). In the same period, there were 197 enquiries for ECMO of whom 118 patients were considered eligible. Overall, 71 patients were cannulated for ECMO; three patients were cannulated for veno-arterial extracorporeal membrane oxygenation (V-A ECMO) due to right sided heart failure and 68 patients were cannulated for V-V ECMO. Two patients accepted for V-V ECMO died during cannulation. The median age was 55 years (IQR 45-60) and 66% were males. The median duration of ECMO support was 13 days (IQR 7-21), mechanical ventilation median 26 days (IQR 14-42), ICU stay median 34 days (IQR 17-46), and length of hospital stay median 41 days (IQR 25-56). Ninety-day mortality was 43%. Age of 60 years or more was associated with an increased risk of mortality. Pre-existing hypertension was associated with a decreased risk of mortality.
CONCLUSION
A nationwide, Danish cohort study of 68 COVID-19 patients supported with V-V ECMO, showed a 90-day survival of 43%, which is in accordance with reports from comparable cohorts. Age of 60 years or more was associated with an increased risk of mortality. Pre-existing hypertension was associated with a decreased risk of mortality.
背景
严重急性呼吸综合征（ARDS）可能需要静脉-静脉体外膜肺氧合（V-V ECMO）。本研究的目的是在一项全国性的 COVID-19 相关 ARDS 患者接受 V-V ECMO 支持的队列研究中提供患者选择和结局的数据。
方法
我们从 2020 年 3 月 10 日至 2021 年 12 月 31 日，确定了在丹麦接受 V-V ECMO 支持的所有 COVID-19 患者，并检索了转至 ECMO 并接受 ECMO 的患者、人口统计学、结局数据和并发症的数据。使用多变量 Cox 回归分析来分析死亡率的危险因素。
结果
在研究期间，1836 名患者被收入丹麦重症监护病房（ICU）。同期，有 197 次 ECMO 咨询，其中 118 名患者被认为符合条件。总体而言，有 71 名患者接受 ECMO 插管；3 名患者因右侧心力衰竭接受了静脉-动脉体外膜肺氧合（V-A ECMO）插管，68 名患者接受了 V-V ECMO 插管。2 名接受 V-V ECMO 的患者在插管过程中死亡。中位年龄为 55 岁（四分位距 45-60），66%为男性。ECMO 支持的中位时间为 13 天（四分位距 7-21），机械通气中位时间为 26 天（四分位距 14-42），ICU 住院中位时间为 34 天（四分位距 17-46），住院中位时间为 41 天（四分位距 25-56）。90 天死亡率为 43%。60 岁或以上的年龄与死亡率增加相关。预先存在的高血压与死亡率降低相关。
结论
一项在丹麦进行的全国性 COVID-19 患者接受 V-V ECMO 支持的队列研究显示，90 天生存率为 43%，与类似队列的报告一致。60 岁或以上的年龄与死亡率增加相关。预先存在的高血压与死亡率降低相关。
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