Evolving outcomes of extracorporeal membrane oxygenation support for severe COVID-19 ARDS in Sorbonne hospitals, Paris
© 2021. The Author(s)..
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) was frequently used to treat patients with severe coronavirus disease-2019 (COVID-19)-associated acute respiratory distress (ARDS) during the initial outbreak. Care of COVID-19 patients evolved markedly during the second part of 2020. Our objective was to compare the characteristics and outcomes of patients who received ECMO for severe COVID-19 ARDS before or after July 1, 2020.
METHODS: We included consecutive adults diagnosed with COVID-19 in Paris-Sorbonne University Hospital Network ICUs, who received ECMO for severe ARDS until January 28, 2021. Characteristics and survival probabilities over time were estimated during the first and second waves. Pre-ECMO risk factors predicting 90-day mortality were assessed using multivariate Cox regression.
RESULTS: Characteristics of the 88 and 71 patients admitted, respectively, before and after July 1, 2020, were comparable except for older age, more frequent use of dexamethasone (18% vs. 82%), high-flow nasal oxygenation (19% vs. 82%) and/or non-invasive ventilation (7% vs. 37%) after July 1. Respective estimated probabilities (95% confidence intervals) of 90-day mortality were 36% (27-47%) and 48% (37-60%) during the first and the second periods. After adjusting for confounders, probability of 90-day mortality was significantly higher for patients treated after July 1 (HR 2.27, 95% CI 1.02-5.07). ECMO-related complications did not differ between study periods.
CONCLUSIONS: 90-day mortality of ECMO-supported COVID-19-ARDS patients increased significantly after July 1, 2020, and was no longer comparable to that of non-COVID ECMO-treated patients. Failure of prolonged non-invasive oxygenation strategies before intubation and increased lung damage may partly explain this outcome.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2021 |
|---|---|
| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:25 |
|---|---|
| Enthalten in: |
Critical care (London, England) - 25(2021), 1 vom: 09. Okt., Seite 355 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Schmidt, Matthieu [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Acute respiratory distress syndrome (ARDS) |
|---|
| Anmerkungen: |
Date Completed 19.10.2021 Date Revised 19.10.2021 published: Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1186/s13054-021-03780-6 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM331682982 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM331682982 | ||
| 003 | DE-627 | ||
| 005 | 20231225214010.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2021 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1186/s13054-021-03780-6 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1105.xml |
| 035 | |a (DE-627)NLM331682982 | ||
| 035 | |a (NLM)34627350 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Schmidt, Matthieu |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Evolving outcomes of extracorporeal membrane oxygenation support for severe COVID-19 ARDS in Sorbonne hospitals, Paris |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 19.10.2021 | ||
| 500 | |a Date Revised 19.10.2021 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021. The Author(s). | ||
| 520 | |a BACKGROUND: Extracorporeal membrane oxygenation (ECMO) was frequently used to treat patients with severe coronavirus disease-2019 (COVID-19)-associated acute respiratory distress (ARDS) during the initial outbreak. Care of COVID-19 patients evolved markedly during the second part of 2020. Our objective was to compare the characteristics and outcomes of patients who received ECMO for severe COVID-19 ARDS before or after July 1, 2020 | ||
| 520 | |a METHODS: We included consecutive adults diagnosed with COVID-19 in Paris-Sorbonne University Hospital Network ICUs, who received ECMO for severe ARDS until January 28, 2021. Characteristics and survival probabilities over time were estimated during the first and second waves. Pre-ECMO risk factors predicting 90-day mortality were assessed using multivariate Cox regression | ||
| 520 | |a RESULTS: Characteristics of the 88 and 71 patients admitted, respectively, before and after July 1, 2020, were comparable except for older age, more frequent use of dexamethasone (18% vs. 82%), high-flow nasal oxygenation (19% vs. 82%) and/or non-invasive ventilation (7% vs. 37%) after July 1. Respective estimated probabilities (95% confidence intervals) of 90-day mortality were 36% (27-47%) and 48% (37-60%) during the first and the second periods. After adjusting for confounders, probability of 90-day mortality was significantly higher for patients treated after July 1 (HR 2.27, 95% CI 1.02-5.07). ECMO-related complications did not differ between study periods | ||
| 520 | |a CONCLUSIONS: 90-day mortality of ECMO-supported COVID-19-ARDS patients increased significantly after July 1, 2020, and was no longer comparable to that of non-COVID ECMO-treated patients. Failure of prolonged non-invasive oxygenation strategies before intubation and increased lung damage may partly explain this outcome | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Acute respiratory distress syndrome (ARDS) | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Extracorporeal membrane oxygenation | |
| 650 | 4 | |a Outcomes | |
| 650 | 4 | |a SARS-CoV-2 | |
| 650 | 4 | |a Venovenous ECMO | |
| 700 | 1 | |a Langouet, Elise |e verfasserin |4 aut | |
| 700 | 1 | |a Hajage, David |e verfasserin |4 aut | |
| 700 | 1 | |a James, Sarah Aissi |e verfasserin |4 aut | |
| 700 | 1 | |a Chommeloux, Juliette |e verfasserin |4 aut | |
| 700 | 1 | |a Bréchot, Nicolas |e verfasserin |4 aut | |
| 700 | 1 | |a Barhoum, Petra |e verfasserin |4 aut | |
| 700 | 1 | |a Lefèvre, Lucie |e verfasserin |4 aut | |
| 700 | 1 | |a Troger, Antoine |e verfasserin |4 aut | |
| 700 | 1 | |a de Chambrun, Marc Pineton |e verfasserin |4 aut | |
| 700 | 1 | |a Hékimian, Guillaume |e verfasserin |4 aut | |
| 700 | 1 | |a Luyt, Charles-Edouard |e verfasserin |4 aut | |
| 700 | 1 | |a Dres, Martin |e verfasserin |4 aut | |
| 700 | 1 | |a Constantin, Jean-Michel |e verfasserin |4 aut | |
| 700 | 1 | |a Fartoukh, Muriel |e verfasserin |4 aut | |
| 700 | 1 | |a Leprince, Pascal |e verfasserin |4 aut | |
| 700 | 1 | |a Lebreton, Guillaume |e verfasserin |4 aut | |
| 700 | 1 | |a Combes, Alain |e verfasserin |4 aut | |
| 700 | 0 | |a GRC RESPIRE Sorbonne Université |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Critical care (London, England) |d 1997 |g 25(2021), 1 vom: 09. Okt., Seite 355 |w (DE-627)NLM097399787 |x 1466-609X |7 nnns |
| 773 | 1 | 8 | |g volume:25 |g year:2021 |g number:1 |g day:09 |g month:10 |g pages:355 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1186/s13054-021-03780-6 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 25 |j 2021 |e 1 |b 09 |c 10 |h 355 | ||