RESUMEN
Objectives: We sought to evaluate 2-year outcome of V-V ECMO support for COVID-19 related severe respiratory failure in our center. Method(s): Retrospective analysis of 41 consecutive patients (73% male, mean age 51.6+/-14.2 years, mean BMI 35.1+/-12.5 kg/m2) with critical hypoxemic and/or hypercapnic refractory respiratory failure (mean P/F ratio 67.9+/-14.3 mmHg, mean pCO2 77.6.0+/-185.7 mmHg, Murray Score 3.71+/-0.4) on V-V ECMO support from October 2020 to January 2022 Results: With mean support duration of 234.4+/-63.2 hours, 29 patients (70.7%) were successfully weaned off. Finally, 19 of them (46.3%) were discharged home with good neurological outcome (CPC 1,2). During followup, 30-day, 6-, 12-, and 24 -month survival rate was 61.3%, 46.2%, 41.9%, and 41,9% respectively. In survivor group shorter symptoms onset to respiratory failure time (4+/-4.7 vs. 7+/-6.7 days, p=0.04), higher P/F ration (86+/-41.5 vs. 65+/-37.5 mmHg, p=0.04) and norepinephrine support (0.03+/-0.06 vs. 0.09+/-0.12 ug/kg/min, p=0.04), and lower IL-6 level (12.3+/-7.5 vs. 25.9+/-8.8 ng/l, p=0.03) p=0.01) were analysed before cannulation. Mean in-ICU stay and in-hospital stay in survivors;groups reached 32.5+/-27.7 days and 42.6+/-35.8 days, respectively. All long-term survivors (17 patients) complained about slight functional health limitation only with normal 6MWT (542.6+/- 89.2 min), near to normal spirometry parameters (FEV/VC 87+/-7.4%, DLCO 63.1+/-13.7%, KCO 82.,1+/-19.4%) and minimal neurological disability (CPC 1-2) Conclusion(s): 2-year outcome of V-V ECMO support in COVID-19 severe respiratory failure is acceptable even in the scope of low-volume ECMO centre. Reported functional status of long-term survivors was good despite the complicated and prolonged in-hospital stay. (Table Presented).
RESUMEN
Objective/Method: Six-month survival analysis of 28 consecutive patients (78.6 % male, mean age 54.3±12.2years, mean BMI 35.3±8.5kg/m2) with critical hypoxemic and/or hypercapnic COVID-19-related severe respiratory failure (mean P/F ratio 69.8±12.3 mmHg, mean pCO2 78.0±15.7 mmHg, Murray Score 3.68±0.4) were supported on V-V ECMO from October 2020 to March 2021. Results: With mean support duration 223.8±65.1 hours, 21 patients (75%) were successfully weaned off. Subsequently, 14 of them (50%) were discharged home with good neurological outcome (CPC 1,2). During follow-up, 30-day, 90-, 180-day survival rate was 64.3%, 53.6% and 42.8%, respectively. Three device-related complications (partial oxygenator thrombosis), 4 thrombotic (1 ischemic stroke, 3 leg cannula-related vein thrombosis), and 3 severe bleeding complications (massive hemothorax, GI bleeding, IC bleeding) occurred. In survivor group shorter length of MV (1.3±0.6 vs. 3.1±3.5, p=0.03), higher P/F ration (74.1±14.2 vs. 61.3±12.1 mmHg, p=0.04), lower IL-6 level (63.5±55.5 vs. 75.9±68.8 ng/l, p=0.04), and D-dimmers (3744.4±4202.3 vs. 6219.9±10431.9 mg/l, p=0.01) were analysed before cannulation. Two late death (≥ 90 day) occurred, as a consequence of critical illness myopathy and recurrent bacterial/fungal pneumonia. Conclusion: Mid-term outcome of V-V ECMO support for COVID-19-related severe respiratory failure is promising even in the scope of lowvolume ECMO centre. Further evaluation of survivors' real quality of life as well as long-term morbidity and mortality analysis is needed.
RESUMEN
Objective: We sought to evaluate interim results of V-V ECMO support for COVID-19-related severe respiratory failure during the 2nd wave of coronavirus pandemic. Methods: A total of 18 consecutive patients (83.3% male, mean age 54.7.8±12.6 years, mean BMI 34.9±9.4 kg/m2) with critical hypoxemic and/or hypercapnic failure (mean P/F ratio 68.5±12.3 mmHg, mean pCO2 78.0±15.7 mmHg) were supported in our centre from October to December 2020. Interim outcome analysis focused on 30-, 60-day survival was conducted. Results: Prior the ECMO, all patients were prone positioned and mechanically ventilated (MV) for the mean of 2.9±2.8 days, subsequently, all were successfully cannulated under ultrasound guidance (83.3%) or angiographic control (16.7%). Mean ECMO support duration reached 217.3±48.5 hours, 15 patients (83.3%) were successfully weaned off. Five patients (27.8%) were discharged home with good neurological outcome (CPC 1,2), 5 patients (27.8%) remained hospitalized, 4 of them in acute rehabilitation centre, and only 1 still remains in ICU with MV dependency. A total of 8 in-hospital deaths (44.4%) were recorded, predominantly due to sepsis-related MOF (75%). During follow-up, 30-day and 60-day survival rate was Kaplan-Meier survival analysis. 72.2% and 55.6%, respectively. One device-related complication (oxygenator thrombosis), 3 thrombotic (1 ischemic stroke, 2 leg cannula-related vein thrombosis), and 1 severe bleeding complications (massive hemothorax) occurred. Conclusions: With respect to limited value of interim results, outcome of V-V ECMO support for COVID-19- related severe respiratory failure is promising even in the scope of low-volume ECMO centre. Long-term outcome analysis including evaluation of survivors' real quality of life is needed.