ABSTRACT
Introduction: One of the great challenges during the COVID-19 pandemic was the management of ventilatory support. Extracorporeal membrane oxygenation (ECMO) was the main strategy for the management of refractory acute respiratory distress syndrome. Objective: Retrospective, multicentre cohort study of adult patients who required extracorporeal membrane oxygenation (ECMO) in participating centers. Clinical and paraclinical characteristics were recorded. A comparison was made between surviving and non-surviving patients. In addition, time from symptom onset to ECMO placement, time from mechanical ventilation, and cannulation were analyzed. Material and methods: Retrospective, multicentre cohort study of adult patients who required extracorporeal membrane oxygenation (ECMO) in participating centers. Clinical and paraclinical characteristics were recorded. A comparison was made between surviving and non-surviving patients. In addition, time from symptom onset to ECMO placement, time from mechanical ventilation, and cannulation were analyzed. Results: Twenty-six patients were included in the analysis. Mortality during ECMO was 42.3% (n = 11) and overall hospital mortality was 65.3% (n = 17). The patient cohort did not differ in terms of sociodemographic characteristics and predictors of mortality at ICU admission between survivors and non-survivors. Mobile ECMO was performed in 10 patients, while 16 were cannulated in situ at the participating centers. The median time from symptom onset to ECMO was 14.5 days (IQR 10.7–21.5), 11 days (IQR 9.5–15.5) in the survivor group, and 17 days (IQR 12.5–27) in non-survivors. The median IMV time was 28.5 (IQR 13–38.25) days. Driving pressure (12 vs 10 cmH2O;p <.01), compliance (37.2 vs 21.4 ml/cmH2O;p <.01), and mechanical power (17.4 vs 11.3 J/min;p =.051) of the respiratory system showed statistically significant differences when comparing survivors and non-survivors, during the 3rd day of ECMO support. Conclusion: In our cohort, mortality after ECMO and after 30 days of hospital stay, was 42.3%, similar to that stated on the extracorporeal life support organization (ELSO) COVID-19 registry dashboard. Information about patients with COVID-19 who required ECMO during the first wave in Argentina was provided in this analysis. © 2022 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo
ABSTRACT
This retrospective multicentre study analyzes epidemiological characteristics, ventilatory mechanics, ECMO settings and outcomes in adult COVID-19 patients treated with ECMO during the first surge in Argentina. The data is obtained from 26 out of 34 patients (76%), representing 4 out of 7 ECMO centers that treated COVID-19 patients. 49 requests for ECMO were received during the study period but 23 were rejected for clinical reasons. 26 patients received ECMO and entered the analysis. Patients were mainly males (80%), aged 50 (IQR 39-60), APACHE 2 10.5 (IQR7,7-16) SOFA 5.5 (IQR 4-8). Mortality during ECMO support was 42 3% (n = 11) while overall hospital mortality was 65 3% (n = 17). Median time from mechanical ventilation to ECMO was 5 days (IQR 2 5-8) vs median 6 days (RIQ 3 5-10 5);p=0 46 for survivors and non survivors respectively. However, time from symptoms onset to ECMO was 14 5 days (IQR 10 7-21 5);with statistically significant differences between survivors and non-survivors [11 days (IQR 9 5-15 5) vs 17 days [IQR 12 5-27] days;p=0 039). Additionally, survivors were characterized by higher baseline respiratory system compliance 31,8 (29-45) vs 22,5 (17-28,5) p<0.001) lower driving pressure 12 vs 18 p<0.001, lower ferritin levels 600 (399-1146) vs 1604 (772-2384) p:0.04 and higher platelet count 346100 (248850-409800) vs 273400 (172000-308000) p:0.04 Non-survivors were characterized by a longer course of disease pre ECMO, and severe pro-inflammatory profile associated with a more advanced and severe lung damage.