tetano
Editor, Senior Moderator
Artif Organs
. 2021 Dec 16.
doi: 10.1111/aor.14136. Online ahead of print.
Extracorporeal membrane oxygenation outcomes in COVID-19 patients: Case series from the Brazilian COVID-19 Registry
Daniela Ponce[SUP] 1 [/SUP], Rafael Lima Rodrigues de Carvalho[SUP] 2 [/SUP], Magda Carvalho Pires[SUP] 3 [/SUP], Heloisa Reniers Vianna[SUP] 4 5 [/SUP], Matheus Carvalho Alves Nogueira[SUP] 6 [/SUP], Fernando Antonio Botoni[SUP] 7 [/SUP], Fernando Graça Aranha[SUP] 8 [/SUP], André Soares de Moura Costa[SUP] 5 [/SUP], Giovanna Grunewald Vietta[SUP] 8 [/SUP], Felipe Ferraz Martins Graça Aranha[SUP] 8 [/SUP], Virginia Mara Reis Gomes[SUP] 9 [/SUP], Ana Paula Beck da Silva Etges[SUP] 2 10 [/SUP], Antonio Tolentino Nogueira de Sá[SUP] 11 [/SUP], Polianna Delfino Pereira[SUP] 7 [/SUP], Milena Soriano Marcolino[SUP] 2 12 [/SUP]
Affiliations
Abstract
Around 5% of coronavirus disease 2019 (COVID-19) patients develop critical disease, with severe pneumonia and acute respiratory distress syndrome (ARDS). In these cases, extracorporeal membrane oxygenation (ECMO) may be considered when conventional therapy fails. This study aimed to describe the clinical characteristics and in-hospital outcomes of COVID-19 patients with ARDS refractory to lung-protective ventilation and prone positioning on ECMO support, as well as to review the available literature on ECMO use and COVID-19 patients' outcome. Patients from this case series were selected from the Brazilian COVID-19 Registry. From the 7646 patients included in the registry, only eight received ECMO support (0.1%), in four hospitals. The median age of the entire sample was 59 (interquartile range 54.2-64.4) years old and 87.5% were male. Hypertension (50.0%), diabetes mellitus (50.0%) and obesity (37.5%) were the most frequent comorbidities. The indications for ECMO were PaO[SUB]2[/SUB] /FiO[SUB]2[/SUB] ratio <80 mm Hg for more than 6 h or PaO[SUB]2[/SUB] /FiO[SUB]2[/SUB] ratio <60 mm Hg for more than 3 h. The mortality rate was 87.5%. In conclusion, in this case series of COVID-19 patients with ARDS refractory to conventional therapy who received ECMO support, a very high mortality was observed. Our findings are not different from previous studies including a small number of patients; however, there is a huge difference from Extracorporeal Life Support Organization results, which encourages us to keep looking for improvement.
Keywords: COVID-19; extracorporeal membrane oxygenation; mortality; propensity score.
. 2021 Dec 16.
doi: 10.1111/aor.14136. Online ahead of print.
Extracorporeal membrane oxygenation outcomes in COVID-19 patients: Case series from the Brazilian COVID-19 Registry
Daniela Ponce[SUP] 1 [/SUP], Rafael Lima Rodrigues de Carvalho[SUP] 2 [/SUP], Magda Carvalho Pires[SUP] 3 [/SUP], Heloisa Reniers Vianna[SUP] 4 5 [/SUP], Matheus Carvalho Alves Nogueira[SUP] 6 [/SUP], Fernando Antonio Botoni[SUP] 7 [/SUP], Fernando Graça Aranha[SUP] 8 [/SUP], André Soares de Moura Costa[SUP] 5 [/SUP], Giovanna Grunewald Vietta[SUP] 8 [/SUP], Felipe Ferraz Martins Graça Aranha[SUP] 8 [/SUP], Virginia Mara Reis Gomes[SUP] 9 [/SUP], Ana Paula Beck da Silva Etges[SUP] 2 10 [/SUP], Antonio Tolentino Nogueira de Sá[SUP] 11 [/SUP], Polianna Delfino Pereira[SUP] 7 [/SUP], Milena Soriano Marcolino[SUP] 2 12 [/SUP]
Affiliations
- PMID: 34913492
- DOI: 10.1111/aor.14136
Abstract
Around 5% of coronavirus disease 2019 (COVID-19) patients develop critical disease, with severe pneumonia and acute respiratory distress syndrome (ARDS). In these cases, extracorporeal membrane oxygenation (ECMO) may be considered when conventional therapy fails. This study aimed to describe the clinical characteristics and in-hospital outcomes of COVID-19 patients with ARDS refractory to lung-protective ventilation and prone positioning on ECMO support, as well as to review the available literature on ECMO use and COVID-19 patients' outcome. Patients from this case series were selected from the Brazilian COVID-19 Registry. From the 7646 patients included in the registry, only eight received ECMO support (0.1%), in four hospitals. The median age of the entire sample was 59 (interquartile range 54.2-64.4) years old and 87.5% were male. Hypertension (50.0%), diabetes mellitus (50.0%) and obesity (37.5%) were the most frequent comorbidities. The indications for ECMO were PaO[SUB]2[/SUB] /FiO[SUB]2[/SUB] ratio <80 mm Hg for more than 6 h or PaO[SUB]2[/SUB] /FiO[SUB]2[/SUB] ratio <60 mm Hg for more than 3 h. The mortality rate was 87.5%. In conclusion, in this case series of COVID-19 patients with ARDS refractory to conventional therapy who received ECMO support, a very high mortality was observed. Our findings are not different from previous studies including a small number of patients; however, there is a huge difference from Extracorporeal Life Support Organization results, which encourages us to keep looking for improvement.
Keywords: COVID-19; extracorporeal membrane oxygenation; mortality; propensity score.