Extracorporeal Membrane Oxygenation for Respiratory Failure Related to COVID-19: A Nationwide Cohort Study-Reference-Cited by-同舟云学术

Extracorporeal Membrane Oxygenation for Respiratory Failure Related to COVID-19: A Nationwide Cohort Study

Published:2022-03-29 Issue:5 Volume:136 Page:732-748
ISSN:0003-3022
Container-title:Anesthesiology
language:en
Short-container-title:

Author:

Nesseler Nicolas¹,Fadel Guillaume²,Mansour Alexandre³,Para Marylou⁴,Falcoz Pierre-Emmanuel⁵,Mongardon Nicolas⁶,Porto Alizée⁷,Bertier Astrid⁸,Levy Bruno⁹,Cadoz Cyril¹⁰,Guinot Pierre-Grégoire¹¹,Fouquet Olivier¹²,Fellahi Jean-Luc¹³,Ouattara Alexandre¹⁴,Guihaire Julien¹⁵,Ruggieri Vito-Giovanni¹⁶,Gaudard Philippe¹⁷,Labaste François¹⁸,Clavier Thomas¹⁹,Brini Kais²⁰,Allou Nicolas²¹,Lacroix Corentin²²,Chommeloux Juliette²³,Lebreton Guillaume²⁴,Matthay Michael A.²⁵,Provenchere Sophie²⁶,Flécher Erwan²⁷,Vincentelli André²⁸,

Affiliation:

1. Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, France; University of Rennes, University Hospital of Rennes, National Institute of Health and Medical Research, Center of Clinical Investigation of Rennes 1414, Rennes, France; University of Rennes, University Hospital of Rennes, National Research Institute for Agriculture, National Institute of Health and Medical Research, Institute of Nutrition, Metabolism, and Cancer, Mixed Research Unit_1341, Mixed Research Unit_1241, Rennes, France.

2. Sorbonne University, National Institute of Health and Medical Research, Mixed Research Unit_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France; Department of Thoracic and Cardiovascular, Cardiology Institute, Public Assistance-Hospitals of Paris, Sorbonne University, Pitié-Salpétriêre Hospital, Paris, France.

3. Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France; University of Rennes, University Hospital of Rennes, National Institute of Health and Medical Research, Center of Clinical Investigation of Rennes 1414, Rennes, France.

4. Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, Public Assistance-Hospitals of Paris, Paris, France; University of Paris, Mixed Research Unit_1148, Laboratory of Vascular Translational Science, Paris, France.

5. National Institute of Health and Medical Research, Mixed Research Unit_1260, Regenerative Nanomedicine, Translational Medicine Federation, Strasbourg, France; University of Strasbourg, Pharmacy and Medical School, Strasbourg, France; University Hospital of Strasbourg, Thoracic Surgery Department, New Hospital Civil, Strasbourg, France.

6. Department of Anesthesia and Critical Care, Medical-University Department, Surgery, Anesthesiology, Surgical Intensive Care Units, University Hospital Department Ageing Thorax-Vessels-Blood, Public Assistance-Hospitals of Paris, Henri Mondor University Hospitals, Créteil, France; University of East Paris Créteil, School of Medicine, Créteil, France; U955-Mondor Institute of Biomedical Research, Equipe 03, Pharmacology and Technologies for Cardiovascular Diseases, National Institute of Health and Medical Research, University of East Paris Créteil, National Veterinary School of Alfort, Maisons-Alfort, France.

7. Department of Cardiac Surgery, Timone Hospital, Marseille Public University Hospital System, 13005, Marseille, France.

8. Intensive Care Unit, Bicêtre Hospital, Public Assistance-Hospitals of Paris, Paris, France.

9. Intensive Care Unit, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandœuvre-lès-Nancy, France; National Institute of Health and Medical Research U1116, Faculty of Medicine, Vandoeuvre-lès-Nancy, France; University of Lorraine, Nancy, France.

10. Polyvalent Intensive Care Unit, Mercy Hospital, Regional Hospital, Metz-Thionville, France.

11. Department of Anesthesiology and Critical Care Medicine, Dijon University Hospital, Dijon, France.

12. Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France; Mitochondrial and Cardiovascular Pathophysiology Institute, French National Centre for Scientific Research, Mixed Research Unit_6214, National Institute of Health and Medical Research U1083, University of Angers, Angers, France.

13. Department of Anesthesia and Critical Care, Louis Pradel Hospital, University Hospital of Lyon, Lyon, France; CarMeN Laboratory, National Institute of Health and Medical Research, Mixed Research Unit_1060, Claude Bernard Lyon University, Lyon, France.

14. University Hospital of Bordeaux, Department of Anesthesia and Critical Care, Magellan Medico-Surgical Center, Bordeaux, France; National Institute of Health and Medical Research, Mixed Research Unit 1034, Biology of Cardiovascular Diseases, Pessac, France.

15. Department of Cardiac Surgery, National Institute of Health and Medical Research, Mixed Research Unit_999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Marie Lannelongue Hospital, Paris Saint-Joseph Hospital Group, University of Paris-Saclay School of Medicine, Le Plessis Robinson, France.

16. Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France.

17. Department of Anesthesia and Critical Care, PhyMedExp, Montpellier University, National Institute of Health and Medical Research, French National Centre for Scientific Research, University Hospital of Montpellier, Montpellier, France.

18. Anesthesiology and Intensive Care Department, University Hospital of Toulouse, Toulouse, France; Metabolic and Cardiovascular Diseases Institute, National Institute of Health and Medical Research U1048, University of Toulouse, Paul Sabatier University, Toulouse, France.

19. Department of Anesthesiology, Critical Care and Perioperative Medicine, University Hospital of Rouen, Rouen, France.

20. Polyvalent and Cardiac Intensive Care Unit, Montsouris Mutualist Institute, Paris, France.

21. Polyvalent Intensive Care Unit, Félix Guyon-Saint-Denis University Hospital, La Réunion, Saint Denis, France.

22. Department of Cardiothoracic Surgery, University Hospital of Poitiers, Poitiers, France.

23. Sorbonne University, National Institute of Health and Medical Research, Mixed Research Unit_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France; Intensive Care Unit, Cardiology Unit, Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France.

24. Sorbonne Université, University, National Institute of Health and Medical Research, Mixed Research Unit_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France; Department of Thoracic and Cardiovascular Surgery, Cardiology Institute, Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France.

25. Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California San Francisco, San Francisco, California.

26. University of Paris, Department of Anesthesiology and Intensive Care, Public Assistance-Hospitals of Paris, Bichat-Claude Bernard Hospital, Paris, France; Clinical Investigation Center 1425, Public Assistance-Hospitals of Paris, National Institute of Health and Medical Research, Paris, France.

27. Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, University of Rennes 1, Signal and Image Treatment Laboratory, National Institute of Health and Medical Research U1099, Rennes, France.

28. Department of Cardiac Surgery, University Hospital of Lille, Lille, France.

Abstract

Background Despite expanding use, knowledge on extracorporeal membrane oxygenation support during the COVID-19 pandemic remains limited. The objective was to report characteristics, management, and outcomes of patients receiving extracorporeal membrane oxygenation with a diagnosis of COVID-19 in France and to identify pre-extracorporeal membrane oxygenation factors associated with in-hospital mortality. A hypothesis of similar mortality rates and risk factors for COVID-19 and non–COVID-19 patients on venovenous extracorporeal membrane oxygenation was made. Methods The Extracorporeal Membrane Oxygenation for Respiratory Failure and/or Heart failure related to Severe Acute Respiratory Syndrome-Coronavirus 2 (ECMOSARS) registry included COVID-19 patients supported by extracorporeal membrane oxygenation in France. This study analyzed patients included in this registry up to October 25, 2020, and supported by venovenous extracorporeal membrane oxygenation for respiratory failure with a minimum follow-up of 28 days after cannulation. The primary outcome was in-hospital mortality. Risk factors for in-hospital mortality were analyzed. Results Among 494 extracorporeal membrane oxygenation patients included in the registry, 429 were initially supported by venovenous extracorporeal membrane oxygenation and followed for at least 28 days. The median (interquartile range) age was 54 yr (46 to 60 yr), and 338 of 429 (79%) were men. Management before extracorporeal membrane oxygenation cannulation included prone positioning for 411 of 429 (96%), neuromuscular blockage for 419 of 427 (98%), and NO for 161 of 401 (40%). A total of 192 of 429 (45%) patients were cannulated by a mobile extracorporeal membrane oxygenation unit. In-hospital mortality was 219 of 429 (51%), with a median follow-up of 49 days (33 to 70 days). Among pre-extracorporeal membrane oxygenation modifiable exposure variables, neuromuscular blockage use (hazard ratio, 0.286; 95% CI, 0.101 to 0.81) and duration of ventilation (more than 7 days compared to less than 2 days; hazard ratio, 1.74; 95% CI, 1.07 to 2.83) were independently associated with in-hospital mortality. Both age (per 10-yr increase; hazard ratio, 1.27; 95% CI, 1.07 to 1.50) and total bilirubin at cannulation (6.0 mg/dl or more compared to less than 1.2 mg/dl; hazard ratio, 2.65; 95% CI, 1.09 to 6.5) were confounders significantly associated with in-hospital mortality. Conclusions In-hospital mortality was higher than recently reported, but nearly half of the patients survived. A high proportion of patients were cannulated by a mobile extracorporeal membrane oxygenation unit. Several factors associated with mortality were identified. Venovenous extracorporeal membrane oxygenation support should be considered early within the first week of mechanical ventilation initiation. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Anesthesiology and Pain Medicine

Link

https://pubs.asahq.org/anesthesiology/article-pdf/136/5/732/672188/20220500.0-00015.pdf

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