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体外膜肺氧合支持治疗COVID

作者:好点的电子游戏平台   时间:2020-09-29 14:10   

本期文章:《柳叶刀》:Online/在线发表

美国密歇根大学Ryan P Barbaro团队研究了体外膜肺氧合支持对COVID-19患者预后的影响。2020年9月25日,该研究发表在《柳叶刀》杂志上。

多个主要健康组织建议使用体外膜肺氧合(ECMO)支持治疗COVID-19相关的急性低氧血症性呼吸衰竭。但使用ECMO治疗COVID-19患者的最初报道中死亡率很高,迄今为止,尚未有关于ECMO治疗COVID-19的大规模国际队列研究。

研究组对36个国家/地区的213家医院中2020年1月16日至5月1日开始接受ECMO支持的16岁以上的COVID-19患者的流行病学、住院病程和临床结局进行了分析。主要结局是院内死亡率。

该研究共包括1035例接受ECMO支持的COVID-19患者的数据。其中67例(6%)仍在住院,311例(30%)出院或转去急救中心,101例(10%)出院转到长期急救中心或未指定地点,176例(17%)被送往另一家医院,380例(37%)死亡。

ECMO开始后90天院内累积死亡率为37.4%。除去仍在住院的患者,死亡率为39%。将ECMO用于循环支持与住院死亡率较高独立相关,风险比为1.89。在接受呼吸(静脉)ECMO且患有急性呼吸窘迫综合征的COVID-19患者亚组中,ECMO开始90天后的院内累积死亡率为38.0%。

总之,在接受ECMO的COVID-19患者中,ECMO后90天的估计死亡率以及最终的真实死亡率均低于40%。

附:英文原文

Title: Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry

Author: Ryan P Barbaro, Graeme MacLaren, Philip S Boonstra, Theodore J Iwashyna, Arthur S Slutsky, Eddy Fan, Robert H Bartlett, Joseph E Tonna, Robert Hyslop, Jeffrey J Fanning, Peter T Rycus, Steve J Hyer, Marc M Anders, Cara L Agerstrand, Katarzyna Hryniewicz, Rodrigo Diaz, Roberto Lorusso, Alain Combes, Daniel Brodie, Peta Alexander, Nicholas Barrett, Jan Bělohlávek, Dale Fisher, John Fraser, Ali Ait Hssain, Jae Sung Jung, Michael McMullan, Yatin Mehta, Mark T. Ogino, Matthew L. Paden, Kiran Shekar, Christine Stead, Yasir Abu-Omar, Vanni Agnoletti, Anzila Akbar, Huda Alfoudri, Carlos Alviar, Vladimir Aronsky, Erin August, Georg Auzinger, Hilda Aveja, Rhonda Bakken, Joan Balcells, Sripal Bangalore, Bernard W. Barnes, Alaiza Bautista, Lorraine L. Bellows, Felipe Beltran, Peyman Benharash, Marco Benni, Jennifer Berg, Pietro Bertini, Pablo Blanco-Schweizer, Melissa Brunsvold, Jenny Budd, Debra Camp, Mark Caridi-Scheible, Edmund Carton, Elena Casanova-Ghosh, Anthony Castleberry, Christopher T. Chipongian, Chang Woo Choi, Alessandro Circelli, Elliott Cohen, Michael Collins, Scott Copus, Jill Coy, Brandon Crist, Leonora Cruz, Mirosaw Czuczwar, Mani Daneshmand, Daniel Davis II, Kim De la Cruz, Cyndie Devers, Toni Duculan, Lucian Durham, Subbarao Elapavaluru, Carlos V. Elzo Kraemer, EDMíLSON CARDOSO Filho, Jillian Fitzgerald, Giuseppe Foti, Matthew Fox, David Fritschen, David Fullerton, Elton Gelandt, Stacy Gerle, Marco Giani, Si Guim Goh, Sara Govener, Julie Grone, Miles Guber, Vadim Gudzenko, Daniel Gutteridge, Jennifer Guy, Jonathan Haft, Cameron Hall, Ibrahim Fawzy Hassan, Rubén Herrán, Hitoshi Hirose, Abdulsalam Saif Ibrahim, Don Igielski, Felicia A. Ivascu, Jaume Izquierdo Blasco, Julie Jackson, Harsh Jain, Bhavini Jaiswal, Andrea C. Johnson, Jenniver A. Jurynec, Norma M Kellter, Adam Kohl, Zachary Kon, Markus Kredel, Karen Kriska, Chandra Kunavarapu, Oude Lansink-Hartgring, Jeliene LaRocque, Sharon Beth Larson, Tracie Layne, Stephane Ledot, Napolitan Lena, Jonathan Lillie, Gsta Lotz, Mark Lucas, Lee Ludwigson, Jacinta J. Maas, Joanna Maertens, David Mast

Issue&Volume: 2020-09-25

Abstract:

Background

Multiple major health organisations recommend the use of extracorporeal membrane oxygenation (ECMO) support for COVID-19-related acute hypoxaemic respiratory failure. However, initial reports of ECMO use in patients with COVID-19 described very high mortality and there have been no large, international cohort studies of ECMO for COVID-19 reported to date.

Methods

We used data from the Extracorporeal Life Support Organization (ELSO) Registry to characterise the epidemiology, hospital course, and outcomes of patients aged 16 years or older with confirmed COVID-19 who had ECMO support initiated between Jan 16 and May 1, 2020, at 213 hospitals in 36 countries. The primary outcome was in-hospital death in a time-to-event analysis assessed at 90 days after ECMO initiation. We applied a multivariable Cox model to examine whether patient and hospital factors were associated with in-hospital mortality.

Findings

Data for 1035 patients with COVID-19 who received ECMO support were included in this study. Of these, 67 (6%) remained hospitalised, 311 (30%) were discharged home or to an acute rehabilitation centre, 101 (10%) were discharged to a long-term acute care centre or unspecified location, 176 (17%) were discharged to another hospital, and 380 (37%) died. The estimated cumulative incidence of in-hospital mortality 90 days after the initiation of ECMO was 37·4% (95% CI 34·4–40·4). Mortality was 39% (380 of 968) in patients with a final disposition of death or hospital discharge. The use of ECMO for circulatory support was independently associated with higher in-hospital mortality (hazard ratio 1·89, 95% CI 1·20–2·97). In the subset of patients with COVID-19 receiving respiratory (venovenous) ECMO and characterised as having acute respiratory distress syndrome, the estimated cumulative incidence of in-hospital mortality 90 days after the initiation of ECMO was 38·0% (95% CI 34·6–41·5).

Interpretation