{"id":19377,"date":"2020-10-16T05:01:34","date_gmt":"2020-10-15T21:01:34","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=19377"},"modified":"2020-10-20T14:52:07","modified_gmt":"2020-10-20T06:52:07","slug":"lancet%e5%9c%a8%e7%ba%bf%e5%8f%91%e8%a1%a8%ef%bc%9aecmo%e6%b2%bb%e7%96%97covid-19-elso%e6%b3%a8%e5%86%8c%e7%9a%84%e5%9b%bd%e9%99%85%e9%98%9f%e5%88%97%e7%a0%94%e7%a9%b6","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=19377","title":{"rendered":"[Lancet\u5728\u7ebf\u53d1\u8868]\uff1aECMO\u6cbb\u7597COVID-19: ELSO\u6ce8\u518c\u7684\u56fd\u9645\u961f\u5217\u7814\u7a76"},"content":{"rendered":"\n

ARTICLES|ONLINE FIRST<\/a><\/p>\n\n\n\n

Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry<\/h1>\n\n\n\n

Ryan P Barbaro, Graeme MacLaren, Philip S Boonstra,\u00a0et al<\/h3>\n\n\n\n

Lancet Published:September 25, 2020 DOI:https:\/\/doi.org\/10.1016\/S0140-6736(20)32008-0<\/a><\/h3>\n\n\n\n

Summary \u6458\u8981<\/h2>\n\n\n\n

Background \u80cc\u666f<\/h3>\n\n\n\n

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.<\/p>\n\n\n\n

\u591a\u4e2a\u91cd\u8981\u7684\u536b\u751f\u673a\u6784\u63a8\u8350ECMO\u7528\u4e8e\u6cbb\u7597COVID-19\u76f8\u5173\u7684\u6025\u6027\u7f3a\u6c27\u6027\u547c\u5438\u529f\u80fd\u8870\u7aed\u3002\u7136\u800c\uff0c\u6700\u521d\u6709\u5173ECMO\u6cbb\u7597COVID-19\u60a3\u8005\u7684\u7814\u7a76\u62a5\u544a\u75c5\u6b7b\u7387\u6781\u9ad8\uff0c\u81f3\u4eca\u6ca1\u6709ECMO\u6cbb\u7597COVID-19\u60a3\u8005\u7684\u5927\u89c4\u6a21\u56fd\u9645\u961f\u5217\u7814\u7a76\u3002<\/p>\n\n\n\n

Methods \u65b9\u6cd5<\/h3>\n\n\n\n

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.<\/p>\n\n\n\n

\u6211\u4eec\u6839\u636eELSO\u6ce8\u518c\u7814\u7a76\u6570\u636e\uff0c\u63cf\u8ff0\u4e862020\u5e741\u670816\u65e5\u81f35\u67081\u65e5\u671f\u95f4\uff0c36\u4e2a\u56fd\u5bb6213\u5bb6\u533b\u9662\u4e2d\u63a5\u53d7ECMO\u6cbb\u7597\u7684\u786e\u8bcaCOVID-19\u6210\u5e74\u60a3\u8005\u7684\u6d41\u884c\u75c5\u5b66\u3001\u4f4f\u9662\u7ecf\u8fc7\u53ca\u4e34\u5e8a\u9884\u540e\u3002\u4e3b\u8981\u9884\u540e\u6307\u6807\u4e3a\u5f00\u59cbECMO\u6cbb\u7597\u540e90\u5929\u7684\u4f4f\u9662\u75c5\u6b7b\u7387\uff08\u91c7\u7528\u65f6\u95f4\u4e8b\u4ef6\u5206\u6790\uff09\u3002\u6211\u4eec\u91c7\u7528\u591a\u56e0\u7d20Cox\u6a21\u578b\u9a8c\u8bc1\u60a3\u8005\u53ca\u533b\u9662\u56e0\u7d20\u4e0e\u4f4f\u9662\u75c5\u6b7b\u7387\u7684\u76f8\u5173\u6027\u3002<\/p>\n\n\n\n

Findings \u7ed3\u679c<\/h3>\n\n\n\n

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\u00b74% (95% CI 34\u00b74\u201340\u00b74). 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\u00b789, 95% CI 1\u00b720\u20132\u00b797). 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\u00b70% (95% CI 34\u00b76\u201341\u00b75).<\/p>\n\n\n\n

\u7814\u7a76\u7eb3\u5165\u4e86\u63a5\u53d7ECMO\u652f\u6301\u6cbb\u7597\u76841035\u540dCOVID-19\u60a3\u8005\u6570\u636e\u3002\u5176\u4e2d\uff0c67\u540d (6%) \u60a3\u8005\u4ecd\u5728\u4f4f\u9662\uff0c311\u540d (30%) \u60a3\u8005\u51fa\u9662\u56de\u5bb6\u6216\u81f3\u6025\u6027\u5eb7\u590d\u4e2d\u5fc3\uff0c101\u540d (10%) \u60a3\u8005\u51fa\u9662\u81f3\u957f\u671f\u6025\u6027\u62a4\u7406\u4e2d\u5fc3\u6216\u53bb\u5411\u4e0d\u8be6\uff0c176\u540d (17%) \u60a3\u8005\u8f6c\u81f3\u5176\u4ed6\u533b\u9662\uff0c380\u540d (37%) \u60a3\u8005\u6b7b\u4ea1\u3002\u5f00\u59cbECMO\u6cbb\u7597\u540e90\u5929\u7d2f\u79ef\u4f4f\u9662\u75c5\u6b7b\u7387\u7ea6\u4e3a37\u00b74% (95% CI 34\u00b74\u201340\u00b74)\u3002\u6700\u540e\u6b7b\u4ea1\u6216\u51fa\u9662\u60c5\u51b5\u660e\u786e\u7684\u60a3\u8005\u75c5\u6b7b\u7387\u4e3a 39% (380\/968)\u3002\u91c7\u7528 ECMO \u8fdb\u884c\u5faa\u73af\u652f\u6301\u4f34\u968f\u4f4f\u9662\u75c5\u6b7b\u7387\u589e\u52a0 (\u98ce\u9669\u6bd4 1\u00b789, 95% CI 1\u00b720\u20132\u00b797)\u3002\u5bf9\u4e8e\u63a5\u53d7\u547c\u5438\u529f\u80fd\u652f\u6301(vvECMO)\u7684ARDS\u60a3\u8005\uff0c\u5f00\u59cbECMO\u6cbb\u7597\u540e90\u5929\u7d2f\u79ef\u4f4f\u9662\u75c5\u6b7b\u7387\u7ea6\u4e3a 38\u00b70% (95% CI 34\u00b76\u201341\u00b75)\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Interpretation \u7ed3\u8bba<\/h3>\n\n\n\n

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.<\/p>\n\n\n\n

\u5bf9\u4e8e\u63a5\u53d7ECMO\u6cbb\u7597\u7684COVID-19\u60a3\u8005\uff0cECMO\u6cbb\u7597\u540e90\u5929\u9884\u8ba1\u75c5\u6b7b\u7387\u4ee5\u53ca\u6700\u7ec8\u7ed3\u5c40\u660e\u786e\u7684\u60a3\u8005\u75c5\u6b7b\u7387\u5747\u4f4e\u4e8e40%\u3002\u5bf9\u4e8e\u63a5\u53d7ECMO\u6cbb\u7597\u7684COVID-19\u60a3\u8005\uff0c\u4ece\u5168\u7403213\u6240\u533b\u9662\u5f97\u5230\u7684\u8fd9\u4e9b\u6570\u636e\u63d0\u4f9b\u4e86\u75c5\u6b7b\u7387\u7684\u53ef\u9760\u6570\u636e\u3002<\/p>\n\n\n\n

Funding \u8d44\u52a9<\/h3>\n\n\n\n

None.<\/p>\n","protected":false},"excerpt":{"rendered":"

ARTICLES|ONLINE FIRST Extracorporeal membrane oxygenati […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19377"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=19377"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19377\/revisions"}],"predecessor-version":[{"id":19378,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19377\/revisions\/19378"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=19377"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=19377"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=19377"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}