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Retrospective Study of Critically Ill COVID-19 Patients With and Without Extracorporeal Membrane Oxygenation Support in Wuhan, China.

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机构： [1]Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union MedicalCollege Hospital, Chinese Academy of Medical Sciences, Beijing, China [2]Department of Medical Administration, NationalHealth Commission of the People’s Republic of China, Beijing, China [3]Department of Medical Critical Care Medicine, StateKey Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of MedicalSciences, Beijing, China [4]Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, SoutheastUniversity, Nanjing, China [5]Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University,Guangzhou, China [6]Department of Critical Care Medicine, Ruijin Hospital Affiliated to Medical College of Shanghai JiaotongUniversity, Shanghai, China [7]Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu,China [8]Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-YangHospital, Capital Medical University, Beijing, China [9]Department of Critical Care Medicine, Zhongnan Hospital of WuhanUniversity, Wuhan, China [10]Department of Critical Care Medicine, Union Hospital, Tongji Medical College, HuazhongUniversity of Science and Technology, Wuhan, China [11]Department of Critical Care Medicine, Northern Jiangsu People’sHospital, Yangzhou, China [12]Department of Critical Care Medicine, Tongji Hospital Affiliated to Tongji Medical CollegeHuazhong University of Science and Technology, Wuhan, China [13]Department of Critical Care Medicine, Sichuan Academyof Medical Sciences & Sichuan Provincial People’s Hospital, Chongqing, China [14]Department of Respiratory and CriticalCare Medicine, China-Japan Friendship Hospital, Beijing, China [15]Department of Critical Care Medicine, The First Hospital ofChina Medical University, Shenyang, China [16]Department of Thoracic Surgery, Wuhan Jinyintan Hospital, Wuhan, China [17]Department of Emergency and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China [18]Department of Pulmonary and Critical Care Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, China [19]Department of Critical Care Medicine, Xuanwu Hospital Capital Medical University, Beijing, China [20]Department of CriticalCare Medicine, Wuhan Pulmonary Hospital, Wuhan, China [21]Department of Cardiovascular Surgery, Zhongshan Hospital,Fudan University, Shanghai, China [22]Department of Cardiology, State Key Laboratory of Complex Severe and RareDiseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China

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Background: Extracorporeal membrane oxygenation (ECMO) might benefit critically ill COVID-19 patients. But the considerations besides indications guiding ECMO initiation under extreme pressure during the COVID-19 epidemic was not clear. We aimed to analyze the clinical characteristics and in-hospital mortality of severe critically ill COVID-19 patients supported with ECMO and without ECMO, exploring potential parameters for guiding the initiation during the COVID-19 epidemic. Methods: Observational cohort study of all the critically ill patients indicated for ECMO support from January 1 to May 1, 2020, in all 62 authorized hospitals in Wuhan, China. Results: Among the 168 patients enrolled, 74 patients actually received ECMO support and 94 not were analyzed. The in-hospital mortality of the ECMO supported patients was significantly lower than non-ECMO ones (71.6 vs. 85.1%, P = 0.033), but the role of ECMO was affected by patients' age (Logistic regression OR 0.62, P = 0.24). As for the ECMO patients, the median age was 58 (47-66) years old and 62.2% (46/74) were male. The 28-day, 60-day, and 90-day mortality of these ECMO supported patients were 32.4, 68.9, and 74.3% respectively. Patients survived to discharge were younger (49 vs. 62 years, P = 0.042), demonstrated higher lymphocyte count (886 vs. 638 cells/uL, P = 0.022), and better CO2 removal (PaCO2 immediately after ECMO initiation 39.7 vs. 46.9 mmHg, P = 0.041). Age was an independent risk factor for in-hospital mortality of the ECMO supported patients, and a cutoff age of 51 years enabled prediction of in-hospital mortality with a sensitivity of 84.3% and specificity of 55%. The surviving ECMO supported patients had longer ICU and hospital stays (26 vs. 18 days, P = 0.018; 49 vs. 29 days, P = 0.001 respectively), and ECMO procedure was widely carried out after the supplement of medical resources after February 15 (67.6%, 50/74). Conclusions: ECMO might be a benefit for severe critically ill COVID-19 patients at the early stage of epidemic, although the in-hospital mortality was still high. To initiate ECMO therapy under tremendous pressure, patients' age, lymphocyte count, and adequacy of medical resources should be fully considered.Copyright © 2021 Cheng, Ma, Su, Long, Liu, Du, Qiu, Guan, Chen, Kang, Tong, Peng, Shang, Zheng, Li, Pan, Huang, Zhan, Ding, Huang, Yin, Li, Li, Jiang, Hu, Li, Zhou, Jing, Guo and Zhang.

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出版当年[2020]版：

大类 | 3 区医学

小类 | 3 区医学：内科

最新[2023]版：

大类 | 3 区医学

小类 | 3 区医学：内科

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出版当年[2019]版：

Q1 MEDICINE, GENERAL & INTERNAL

最新[2023]版：

Q1 MEDICINE, GENERAL & INTERNAL

影响因子： 3.1 最新[2023版] 3.4 最新五年平均 3.9 出版当年[2019版] 0 出版当年五年平均 3.113 出版前一年[2018版] 5.093 出版后一年[2020版]

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第一作者机构： [1]Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union MedicalCollege Hospital, Chinese Academy of Medical Sciences, Beijing, China

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