从第二波到大流行结束（EuroECMO-COVID），接受体外膜氧合治疗的COVID-19患者的住院结局和6个月随访结果：一项前瞻性、国际、多中心观察性研究

IF 38.7 1区医学 Q1 CRITICAL CARE MEDICINE

Lancet Respiratory Medicine Pub Date : 2025-02-23 DOI:10.1016/s2213-2600(24)00369-2

Maria Elena De Piero, Silvia Mariani, Bas C T van Bussel, Dominik Jarczak, Niklas Krenner, Enrique Perez de la Sota, Pedro E Silva, Magdalena Roemmer, Mariusz Kowalewski, Simone Carelli, Lars Mikael Broman, Alain Vuylsteke, Philip Fortuna, Francesco Alessandri, Gennaro Martucci, Brijesh V Patel, Gosta Lotz, Udo Boeken, Sven Maier, Bursa Filip, Robert Loveridge

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引用次数: 0

摘要

在第一波大流行期间，对COVID-19的体外膜氧合（ECMO）进行了全面评估，但随后几波大流行的数据有限。我们的目标是调查从第二次大流行（2020年9月15日）到大流行结束（世卫组织宣布的2023年3月21日）期间，采用体外膜肺栓塞（ECMO）支持的COVID-19患者的住院和6个月生存率。euecmo - covid是一项前瞻性观察性研究，包括来自21个国家98个中心的需要ECMO呼吸支持的COVID-19成人（年龄≥16岁）。我们比较了住院幸存者和非幸存者的患者特征和结果。使用混合效应多变量logistic回归来调查与住院死亡率相关的因素。6个月生存率和总体患者状态通过患者接触或图表审查确定。本研究已在ClinicalTrials.gov注册，编号NCT04366921，现已完成。结果：纳入3860例患者，其中男性2687例（69.7%），女性1169例（30.3%）；中位年龄51岁[SD 11])，来自21个国家的98个中心。住院死亡率为55.9% (n=2158)，其中80.2% （n=1752）死亡发生在ECMO支持期间。与幸存者相比，更多的非幸存者患有糖尿病、高血压、心血管疾病和肾衰竭，并且需要更多的ecmo前肌力药物和血管加压药物。两组的中位支持时间均为18天（IQR 10-31）。与住院死亡率相关的因素包括年龄较大、ECMO前肾功能衰竭、ECMO前血管加压剂的使用、从插管到ECMO启动的时间较长以及并发症，包括神经系统事件、败血症、肠缺血、肾功能衰竭和出血。在1702例（44.1%）住院幸存者中，99.7% （n=1697）在随访6个月时存活。许多患者在6个月的随访中出现呼吸困难（1568例患者中501例[32.0%]）、心脏（1568例患者中122例[7.8%]）或神经认知（1567例患者中168例[10.7%]）症状。我们对第二波COVID-19之后因呼吸窘迫而接受ECMO支持的患者的数据证实了第一波关于患者特征和院内死亡率相关因素的大多数发现。尽管如此，住院死亡率高于最初的大流行浪潮，而出院后6个月生存率仍然良好（99.7%）。出院后症状的持续存在证实了ecmo后患者随访计划的必要性。

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In-hospital outcomes and 6-month follow-up results of patients supported with extracorporeal membrane oxygenation for COVID-19 from the second wave to the end of the pandemic (EuroECMO-COVID): a prospective, international, multicentre, observational study

Background

Extracorporeal membrane oxygenation (ECMO) for COVID-19 was thoroughly assessed during the first pandemic wave, but data on subsequent waves are limited. We aimed to investigate in-hospital and 6-month survival of patients with COVID-19 supported with ECMO from the second pandemic wave (Sept 15, 2020) until the end of the pandemic (March 21, 2023, announced by WHO).

Methods

EuroECMO-COVID is a prospective, observational study including adults (aged ≥16 years) requiring ECMO respiratory support for COVID-19 from 98 centres in 21 countries. We compared patient characteristics and outcomes between in-hospital survivors and non-survivors. Mixed-effects multivariable logistic regressions were used to investigate factors linked to in-hospital mortality. 6-month survival and overall patient status were determined via patient contact or chart review. This study is registered with ClinicalTrials.gov, NCT04366921, and is complete.

Findings

We included 3860 patients (2687 [69·7%] were male and 1169 [30·3%] were female; median age 51 years [SD 11]) from 98 centres in 21 countries. In-hospital mortality was 55·9% (n=2158), with 81·2% (n=1752) deaths occurring during ECMO support. More non-survivors had diabetes, hypertension, cardiovascular disease, and renal failure, and required more pre-ECMO inotropes and vasopressors compared with survivors. Median support duration was 18 days (IQR 10–31) for both groups. Factors linked to in-hospital mortality included older age, pre-ECMO renal failure, pre-ECMO vasopressors use, longer time from intubation to ECMO initiation, and complications, including neurological events, sepsis, bowel ischaemia, renal failure, and bleeding. Of the 1702 (44·1%) in-hospital survivors, 99·7% (n=1697) were alive at 6 months follow-up. Many patients at 6 months follow-up had dyspnoea (501 [32·0%] of 1568 patients), cardiac (122 [7·8%] of 1568 patients), or neurocognitive (168 [10·7%] of 1567 patients) symptoms.

Interpretation

Our data for patients undergoing ECMO support for respiratory distress from the second COVID-19 wave onwards confirmed most findings from the first wave regarding patient characteristics and factors correlated to in-hospital mortality. Nevertheless, in-hospital mortality was higher than during the initial pandemic wave while 6-month post-discharge survival remained favourable (99·7%). Persisting post-discharge symptoms confirmed the need for post-ECMO patient follow-up programmes.

Funding

None.

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来源期刊

Lancet Respiratory Medicine RESPIRATORY SYSTEM-RESPIRATORY SYSTEM

CiteScore

87.10

自引率

0.70%

发文量

572

期刊介绍： The Lancet Respiratory Medicine is a renowned journal specializing in respiratory medicine and critical care. Our publication features original research that aims to advocate for change or shed light on clinical practices in the field. Additionally, we provide informative reviews on various topics related to respiratory medicine and critical care, ensuring a comprehensive coverage of the subject. The journal covers a wide range of topics including but not limited to asthma, acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD), tobacco control, intensive care medicine, lung cancer, cystic fibrosis, pneumonia, sarcoidosis, sepsis, mesothelioma, sleep medicine, thoracic and reconstructive surgery, tuberculosis, palliative medicine, influenza, pulmonary hypertension, pulmonary vascular disease, and respiratory infections. By encompassing such a broad spectrum of subjects, we strive to address the diverse needs and interests of our readership.