Journal of Chest Surgery

  • 제57권1호
  • /
  • Pages.36-43
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  • 2024
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  • 2765-1606(pISSN)
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  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
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Outcomes of Extracorporeal Membrane Oxygenation in COVID-19: A Single-Center Study

  • Sahri Kim (Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital) ;
  • Jung Hyun Lim (Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital) ;
  • Ho Hyun Ko (Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital) ;
  • Hong Kyu Lee (Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital) ;
  • Yong Joon Ra (Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital) ;
  • Kunil Kim (Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital) ;
  • Hyoung Soo Kim (Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital)
  • 투고 : 2023.08.04
  • 심사 : 2023.10.24
  • 발행 : 2024.01.05
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초록

Background: Coronavirus disease 2019 (COVID-19) can lead to acute respiratory failure, which frequently necessitates invasive mechanical ventilation and extracorporeal membrane oxygenation (ECMO). However, the limited availability of ECMO resources poses challenges to patient selection and associated decision-making. Consequently, this retrospective single-center study was undertaken to evaluate the characteristics and clinical outcomes of patients with COVID-19 receiving ECMO. Methods: Between March 2020 and July 2022, 65 patients with COVID-19 were treated with ECMO and were subsequently reviewed. Patient demographics, laboratory data, and clinical outcomes were examined, and statistical analyses were performed to identify risk factors associated with mortality. Results: Of the patients studied, 15 (23.1%) survived and were discharged from the hospital, while 50 (76.9%) died during their hospitalization. The survival group had a significantly lower median age, at 52 years (interquartile range [IQR], 47.5-61.5 years), compared to 64 years (IQR, 60.0-68.0 years) among mortality group (p=0.016). However, no significant differences were observed in other underlying conditions or in factors related to intervention timing. Multivariable analysis revealed that the requirement of a change in ECMO mode (odds ratio [OR], 366.77; 95% confidence interval [CI], 1.92-69911.92; p=0.0275) and the initiation of continuous renal replacement therapy (CRRT) (OR, 139.15; 95% CI, 1.95-9,910.14; p=0.0233) were independent predictors of mortality. Conclusion: Changes in ECMO mode and the initiation of CRRT during management were associated with mortality in patients with COVID-19 who were supported by ECMO. Patients exhibiting these factors require careful monitoring due to the potential for adverse outcomes.

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참고문헌

  1. World Health Organization. Coronavirus disease (COVID-19) pandemic [Internet]. World Health Organization; 2020 [cited 2023 Jul 8]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
  2. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395: 497-506. https://doi.org/10.1016/S0140-6736(20)30183-5
  3. Bertini P, Guarracino F, Falcone M, et al. ECMO in COVID-19 patients: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth 2022;36(8 Pt A):2700-6. https://doi.org/10.1053/j.jvca.2021.11.006
  4. Yaqoob H, Greenberg D, Huang L, et al. Extracorporeal membrane oxygenation in COVID-19 compared to other etiologies of acute respiratory failure: a single-center experience. Heart Lung 2023;57: 243-9. https://doi.org/10.1016/j.hrtlng.2022.10.003
  5. Ramanathan K, Shekar K, Ling RR, et al. Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis. Crit Care 2021;25:211. https://doi.org/10.1186/s13054-021-03634-1
  6. Badulak J, Antonini MV, Stead CM, et al. Extracorporeal Membrane Oxygenation for COVID-19: updated 2021 guidelines from the Extracorporeal Life Support Organization. ASAIO J 2021;67:485-95. https://doi.org/10.1097/MAT.0000000000001422
  7. Alhazzani W, Moller MH, Arabi YM, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med 2020; 46:854-87. https://doi.org/10.1007/s00134-020-06022-5
  8. Makhoul M, Keizman E, Carmi U, et al. Outcomes of extracorporeal membrane oxygenation (ECMO) for COVID-19 patients: a multi-institutional analysis. Vaccines (Basel) 2023;11:108. https://doi.org/10.3390/vaccines11010108
  9. Urner M, Barnett AG, Bassi GL, et al. Venovenous extracorporeal membrane oxygenation in patients with acute COVID-19 associated respiratory failure: comparative effectiveness study. BMJ 2022;377:e068723. https://doi.org/10.1136/bmj-2021-068723
  10. Baez-Ferrer N, Bompart-Cairos A, Lopez-Rial D, Abreu-Gonzalez P, Hernandez-Vaquero D, Dominguez-Rodriguez A. Mortality with ECMO in critically ill patients with SARS-CoV-2 infection during the COVID-19 pandemic: a systematic review. REC Interv Cardiol 2021;3:196-203. https://doi.org/10.24875/RECICE.M21000207
  11. Kieninger B, Kilger M, Foltan M, et al. Prognostic factors for favorable outcomes after veno-venous extracorporeal membrane oxygenation in critical care patients with COVID-19. PLoS One 2023;18:e0280502. https://doi.org/10.1371/journal.pone.0280502
  12. Tran A, Fernando SM, Rochwerg B, et al. Prognostic factors associated with mortality among patients receiving venovenous extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis. Lancet Respir Med 2023;11:235-44. https://doi.org/10.1016/S2213-2600(22)00296-X
  13. Yang X, Cai S, Luo Y, et al. Extracorporeal membrane oxygenation for coronavirus disease 2019-induced acute respiratory distress syndrome: a multicenter descriptive study. Crit Care Med 2020;48:1289-95. https://doi.org/10.1097/CCM.0000000000004447
  14. Henry BM, Lippi G. Poor survival with extracorporeal membrane oxygenation in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19): pooled analysis of early reports. J Crit Care 2020;58:27-8. https://doi.org/10.1016/j.jcrc.2020.03.011
  15. Liu Y, Sun W, Guo Y, et al. Association between platelet parameters and mortality in coronavirus disease 2019: retrospective cohort study. Platelets 2020;31:490-6. https://doi.org/10.1080/09537104.2020.1754383
  16. Zampieri FG, Ranzani OT, Sabatoski V, et al. An increase in mean platelet volume after admission is associated with higher mortality in critically ill patients. Ann Intensive Care 2014;4:20. https://doi.org/10.1186/s13613-014-0020-1
  17. Zaaqoq A, Sallam T, Merley C, et al. The interplay of inflammation and coagulation in COVID-19 patients receiving extracorporeal membrane oxygenation support. Perfusion 2023;38:384-92. https://doi.org/10.1177/02676591211057506
  18. Lefrancais E, Looney MR. Platelet biogenesis in the lung circulation. Physiology (Bethesda) 2019;34:392-401. https://doi.org/10.1152/physiol.00017.2019
  19. Barbaro RP, MacLaren G, Boonstra PS, et al. Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry. Lancet 2020;396:1071-8. https://doi.org/10.1016/S0140-6736(20)32008-0
  20. Lee JJ, Hwang SM, Ko JH, et al. Efficacy of veno-venous extracorporeal membrane oxygenation in severe acute respiratory failure. Yonsei Med J 2015;56:212-9. https://doi.org/10.3349/ymj.2015.56.1.212
  21. Jeong IS, Kim WH, Baek JH, et al. Extracorporeal membrane oxygenation for coronavirus disease 2019: expert recommendations from the Korean Society for Thoracic and Cardiovascular Surgery. J Chest Surg 2021;54:2-8. https://doi.org/10.5090/kjtcs.21.001