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[Lancet Respir Med在线发表]:ECMO治疗新冠肺炎合并重度ARDS:回顾队列研究
2020年09月18日 时讯速递, 进展交流 暂无评论

Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: a retrospective cohort study

Matthieu Schmidt, David Hajage, Guillaume Lebreton

Lancet Respir Med Published:August 13, 2020 DOI:https://doi.org/10.1016/S2213-2600(20)30328-3

Summary 摘要

Background 背景

Patients with COVID-19 who develop severe acute respiratory distress syndrome (ARDS) can have symptoms that rapidly evolve to profound hypoxaemia and death. The efficacy of extracorporeal membrane oxygenation (ECMO) for patients with severe ARDS in the context of COVID-19 is unclear. We aimed to establish the clinical characteristics and outcomes of patients with respiratory failure and COVID-19 treated with ECMO.

发生重度ARDS的新冠肺炎患者临床症状迅速进展为严重低氧血症甚至死亡。ECMO对于新冠肺炎导致的ARDS患者的疗效并不明确。我们旨在明确接受ECMO治疗合并呼吸功能衰竭的新冠肺炎患者的临床特征及预后。

Methods 方法

This retrospective cohort study was done in the Paris–Sorbonne University Hospital Network, comprising five intensive care units (ICUs) and included patients who received ECMO for COVID-19 associated ARDS. Patient demographics and daily pre-ECMO and on-ECMO data and outcomes were collected. Possible outcomes over time were categorised into four different states (states 1–4): on ECMO, in the ICU and weaned off ECMO, alive and out of ICU, or death. Daily probabilities of occupation in each state and of transitions between these states until day 90 post-ECMO onset were estimated with use of a multi-state Cox model stratified for each possible transition. Follow-up was right-censored on July 10, 2020.

这项回顾队列研究在Paris–Sorbonne大学医院网络进行,5个ICU参加,纳入接受ECMO治疗的新冠肺炎合并ARDS患者。收集患者人口统计学资料,已经ECMO前和应用ECMO过程中每日资料和预后。根据可能的时间相关预后分为4种不同状态(状态 1–4):使用ECMO过程中,仍在 ICU但脱离 ECMO,存活且转出ICU,或死亡。采用多状态Cox模型,针对每种可能转变分层,计算每日在各种状态及之间转变的概率。随访截止到2020年7月10日。

Findings 结果

From March 8 to May 2, 2020, 492 patients with COVID-19 were treated in our ICUs. Complete day-60 follow-up was available for 83 patients (median age 49 [IQR 41–56] years and 61 [73%] men) who received ECMO. Pre-ECMO, 78 (94%) patients had been prone-positioned; their median driving pressure was 18 (IQR 16–21) cm H2O and PaO2/FiO2 was 60 (54–68) mm Hg. At 60 days post-ECMO initiation, the estimated probabilities of occupation in each state were 6% (95% CI 3–14) for state 1, 18% (11–28) for state 2, 45% (35–56) for state 3, and 31% (22–42) for state 4. 35 (42%) patients had major bleeding and four (5%) had a haemorrhagic stroke. 30 patients died.

从2020年3月8日至5月2日,ICU共收治492名新冠肺炎患者。其中83名(中位年龄 49 [IQR 41–56] 岁,61名 [73%] 为女性)患者有完整的60天随访记录。在ECMO前,78名 (94%) 患者接受俯卧位;驱动压中位数18 (IQR 16–21) cm H2O,PaO2/FiO2 为 60 (54–68) mm Hg。开始ECMO治疗后60天,估测在每种状态的概率分别是状态1为 6% (95% CI 3–14),状态2为18% (11–28),状态3为 45% (35–56),状态4为 31% (22–42)。35名 (42%) 患者有大出血,4名患者 (5%) 发生出血性卒中。30名患者死亡。

Interpretation 结论

The estimated 60-day survival of ECMO-rescued patients with COVID-19 was similar to that of studies published in the past 2 years on ECMO for severe ARDS. If another COVID-19 outbreak occurs, ECMO should be considered for patients developing refractory respiratory failure despite optimised care.

对于接受ECMO治疗的新冠肺炎患者,估测60天存活率与既往2年发表的ECMO治疗重度ARDS相似。如果再次发生新冠肺炎的暴发流行,对于接受优化治疗后仍有顽固性呼吸功能衰竭的患者,应当考虑使用ECMO。

Funding 资助

None.

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