tetano
Editor, Senior Moderator
Ann Intensive Care
. 2022 Jan 13;12(1):6.
doi: 10.1186/s13613-022-00980-3.
Duration of invasive mechanical ventilation prior to extracorporeal membrane oxygenation is not associated with survival in acute respiratory distress syndrome caused by coronavirus disease 2019
Martina Hermann[SUP] 1 2 [/SUP], Daniel Laxar[SUP] 2 [/SUP], Christoph Krall[SUP] 3 [/SUP], Christina Hafner[SUP] 1 2 [/SUP], Oliver Herzog[SUP] 1 [/SUP], Oliver Kimberger[SUP] 1 2 [/SUP], Sebastian Koenig[SUP] 1 [/SUP], Felix Kraft[SUP] 1 [/SUP], Mathias Maleczek[SUP] 1 2 [/SUP], Klaus Markstaller[SUP] 1 [/SUP], Oliver Robak[SUP] 4 [/SUP], Bernhard Rössler[SUP] 1 [/SUP], Eva Schaden[SUP] 1 2 [/SUP], Peter Schellongowski[SUP] 4 [/SUP], Mathias Schneeweiss-Gleixner[SUP] 5 [/SUP], Thomas Staudinger[SUP] 4 [/SUP], Roman Ullrich[SUP] 1 [/SUP], Marion Wiegele[SUP] 1 [/SUP], Harald Willschke[SUP] 1 2 [/SUP], Christian Zauner[SUP] 5 [/SUP], Alexander Hermann[SUP] 6 [/SUP]
Affiliations
- PMID: 35024972
- DOI: 10.1186/s13613-022-00980-3
Abstract
Background: Duration of invasive mechanical ventilation (IMV) prior to extracorporeal membrane oxygenation (ECMO) affects outcome in acute respiratory distress syndrome (ARDS). In coronavirus disease 2019 (COVID-19) related ARDS, the role of pre-ECMO IMV duration is unclear. This single-centre, retrospective study included critically ill adults treated with ECMO due to severe COVID-19-related ARDS between 01/2020 and 05/2021. The primary objective was to determine whether duration of IMV prior to ECMO cannulation influenced ICU mortality.
Results: During the study period, 101 patients (mean age 56 [SD ± 10] years; 70 [69%] men; median RESP score 2 [IQR 1-4]) were treated with ECMO for COVID-19. Sixty patients (59%) survived to ICU discharge. Median ICU length of stay was 31 [IQR 20.7-51] days, median ECMO duration was 16.4 [IQR 8.7-27.7] days, and median time from intubation to ECMO start was 7.7 [IQR 3.6-12.5] days. Fifty-three (52%) patients had a pre-ECMO IMV duration of > 7 days. Pre-ECMO IMV duration had no effect on survival (p = 0.95). No significant difference in survival was found when patients with a pre-ECMO IMV duration of < 7 days (< 10 days) were compared to ≥ 7 days (≥ 10 days) (p = 0.59 and p = 1.0).
Conclusions: The role of prolonged pre-ECMO IMV duration as a contraindication for ECMO in patients with COVID-19-related ARDS should be scrutinised. Evaluation for ECMO should be assessed on an individual and patient-centred basis.
Keywords: Acute respiratory distress syndrome; COVID-19; Extracorporeal membrane oxygenation; Invasive mechanical ventilation.