首页|Extracorporeal Membrane Oxygenation Therapy for Critically Ill Coronavirus Disease 2019 Patients in Wuhan,China:A Retrospective Multicenter Cohort Study

Extracorporeal Membrane Oxygenation Therapy for Critically Ill Coronavirus Disease 2019 Patients in Wuhan,China:A Retrospective Multicenter Cohort Study

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Currently,little in-depth evidence is known about the application of extracorporeal membrane oxygenation(ECMO)therapy in coronavirus disease 2019(COVID-19)patients.This retrospective multicenter cohort study included patients with COVID-19 at 7 designated hospitals in Wuhan,China.The patients were followed up until June 30,2020.Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with unsuccessful ECMO weaning.Propensity score matching was used to match patients who received veno-venous ECMO with those who received invasive mechanical ventilation(IMV)-only therapy.Of 88 patients receiving ECMO therapy,27 and 61 patients were and were not successfully weaned from ECMO,respectively.Additionally,15,15,and 65 patients were further weaned from IMV,discharged from hospital,or died during hospitalization,respectively.In the multivariate logistic regression analysis,a lymphocyte count ≤0.5×109/L and D-dimer concentration ＞4x the upper limit of normal level at ICU admission,a peak PaCO2 ＞60 mmHg at 24 h before ECMO initiation,and no tracheotomy performed during the ICU stay were independently associated with lower odds of ECMO weaning.In the propensity score-matched analysis,a mixed-effect Cox model detected a lower hazard ratio for 120-day all-cause mortality after ICU admission during hospitalization in the ECMO group.The presence of lymphocytopenia,higher D-dimer concentrations at ICU admission and hypercapnia before ECMO initiation could help to identify patients with a poor prognosis.Tracheotomy could facilitate weaning from ECMO.ECMO relative to IMV-only therapy was associated with improved outcomes in critically ill COVID-19 patients.

coronavirus disease 2019extracorporeal membrane oxygenationmechanical ventilationacute respiratory distress syndromeviral pneumonia

Jing FANG、Rui LI、Yue CHEN、Juan-juan QIN、Ming HU、Chao-lin HUANG、Lin CHENG、Yi HE、Yi LI、Qiang ZHOU、Dai-xing ZHOU、Fei HUANG、Fang LEI、Bo YANG、Jun CHEN、Hong-ping DENG、Yu-feng YUAN、Jia-hong XIA、Song WAN、Hong-liang LI、Xiang WEI

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Division of Cardiothoracic and Vascular Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China

Key Laboratory of Organ Transplantation,Ministry of Education,Wuhan 430030,China

NHC Key Laboratory of Organ Transplantation,Ministry of Health,Wuhan 430030,China

Key Laboratory of Organ Transplantation,Chinese Academy of Medical Sciences,Wuhan 430030,China

National Public Health Event Medical Center,National Health Commission of the People's Republic of Chi

Department of Cardiology,Renmin Hospital of Wuhan University,Wuhan 430060,China

Basic Medical School,Wuhan University,Wuhan 430071,China

Department of Critical Care Medicine,Wuhan Pulmonary Hospital,Wuhan 430030,China

Wuhan Jinyintan Hospital,Wuhan 430023,China

Division of Cardiology,Department of Internal Medicine,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China

Department of Intensive Critical Medicine,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China

Institute of Model Animal of Wuhan University,Wuhan 430071,China

Department of Cardiac Surgery,University of Michigan,Ann Arbor,MI 48109,USA

Department of Vascular Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,China

Department of Hepatobiliary and Pancreatic Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China

Department of Cardiovascular Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China

Division of Cardiothoracic Surgery,Department of Surgery,the Chinese University of Hong Kong,Prince of Wales Hospital,Hong Kong,999077 China

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This work was supported by grants from Emergent Key Projects for COVID-19National Natural Science Foundation of ChinaNational Natural Science Foundation of ChinaNational Natural Science Foundation of Chinaand National Key Research and Development Program of China

2020kfyXGYJ091Nos.8180025681873458816700502019YFC0121600

2021

10.1007/s11596-021-2311-8

当代医学科学(英文)
同济医科大学

当代医学科学(英文)

SCI
ISSN：2096-5230
年,卷(期)：2021.41(1)
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