التفاصيل البيبلوغرافية
| العنوان: |
Evolving outcomes of extracorporeal membrane oxygenation support for severe COVID-19 ARDS in Sorbonne hospitals, Paris. |
| المؤلفون: |
Schmidt, Matthieu, Langouet, Elise, Hajage, David, James, Sarah Aissi, Chommeloux, Juliette, Bréchot, Nicolas, Barhoum, Petra, Lefèvre, Lucie, Troger, Antoine, de Chambrun, Marc Pineton, Hékimian, Guillaume, Luyt, Charles-Edouard, Dres, Martin, Constantin, Jean-Michel, Fartoukh, Muriel, Leprince, Pascal, Lebreton, Guillaume, Combes, Alain, GRC RESPIRE Sorbonne Université |
| المصدر: |
Critical Care; 10/9/2021, Vol. 25 Issue 1, p1-11, 11p |
| مستخلص: |
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. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
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