现在的位置: 首页时讯速递, 进展交流>正文
[Lancet在线发表]:ECMO治疗COVID-19: ELSO注册的国际队列研究
2020年10月16日 时讯速递, 进展交流 暂无评论

ARTICLES|ONLINE FIRST

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

Ryan P Barbaro, Graeme MacLaren, Philip S Boonstra, et al

Lancet Published:September 25, 2020 DOI:https://doi.org/10.1016/S0140-6736(20)32008-0

Summary 摘要

Background 背景

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.

多个重要的卫生机构推荐ECMO用于治疗COVID-19相关的急性缺氧性呼吸功能衰竭。然而,最初有关ECMO治疗COVID-19患者的研究报告病死率极高,至今没有ECMO治疗COVID-19患者的大规模国际队列研究。

Methods 方法

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.

我们根据ELSO注册研究数据,描述了2020年1月16日至5月1日期间,36个国家213家医院中接受ECMO治疗的确诊COVID-19成年患者的流行病学、住院经过及临床预后。主要预后指标为开始ECMO治疗后90天的住院病死率(采用时间事件分析)。我们采用多因素Cox模型验证患者及医院因素与住院病死率的相关性。

Findings 结果

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).

研究纳入了接受ECMO支持治疗的1035名COVID-19患者数据。其中,67名 (6%) 患者仍在住院,311名 (30%) 患者出院回家或至急性康复中心,101名 (10%) 患者出院至长期急性护理中心或去向不详,176名 (17%) 患者转至其他医院,380名 (37%) 患者死亡。开始ECMO治疗后90天累积住院病死率约为37·4% (95% CI 34·4–40·4)。最后死亡或出院情况明确的患者病死率为 39% (380/968)。采用 ECMO 进行循环支持伴随住院病死率增加 (风险比 1·89, 95% CI 1·20–2·97)。对于接受呼吸功能支持(vvECMO)的ARDS患者,开始ECMO治疗后90天累积住院病死率约为 38·0% (95% CI 34·6–41·5)。

Interpretation 结论

In patients with COVID-19 who received ECMO, both estimated mortality 90 days after ECMO and mortality in those with a final disposition of death or discharge were less than 40%. These data from 213 hospitals worldwide provide a generalisable estimate of ECMO mortality in the setting of COVID-19.

对于接受ECMO治疗的COVID-19患者,ECMO治疗后90天预计病死率以及最终结局明确的患者病死率均低于40%。对于接受ECMO治疗的COVID-19患者,从全球213所医院得到的这些数据提供了病死率的可靠数据。

Funding 资助

None.

给我留言

您必须 [ 登录 ] 才能发表留言!

×
腾讯微博