Refractory circulatory failure in COVID-19 patients treated with veno-arterial ECMO: A retrospective single-center experience
Perfusion
; 38(1 Supplement):96-97, 2023.
Article
Dans Anglais
| EMBASE | ID: covidwho-20244671
ABSTRACT
Objectives:
Data about COVID-19 patients treated with veno-arterial-ECMO (VA-ECMO) is limited. Reported survival rates range from 27.9% to 77.8%, depending on VA-ECMO indication. A subgroup of patients suffers from circulatory failure due to a COVID-19 associated hyperinflammatory state (CovHI). In these patients, differentiation between inflammation and sepsis is difficult but important. In this retrospective case series, differential diagnoses of COVID-19 associated refractory circulatory failure and survival rates in different indications for VA-ECMO are investigated. Method(s) Retrospective analysis of 28 consecutive COVID-19 patients requiring VA-ECMO at the University Hospital Regensburg between March 2020 and May 2022. Specific treatment for COVID-19 was in accordance with respective guidelines. Mycotic infections were either invasive or met current definitions of COVID19-associated-pulmonary aspergillosis. Result(s) At VA-ECMO initiation, median age was 57.3 years (IQR 51.4 - 61.8), SOFA score 16 (IQR 13 - 17) and norepinephrine dosing 0.53mug/kg/min (IQR 0.32 - 0.78). Virus-variants were 61% wild-type, 14% Alpha, 18% Delta and 7% Omicron. Survival to hospital discharge was 39%. 17 patients were primarily supported with VA-ECMO only (survival 42%), 3 patients were switched from VV to VA-ECMO (survival 0%), and 8 patients were converted from VA to VAV or VV-ECMO (survival 50%). Indications for VA-ECMO support were pulmonary embolism (PE) (n=5, survival 80%), right heart failure due to secondary pulmonary hypertension (n=5, survival 20%), cardiac arrest (n=4, survival 25%), acute left heart failure (ALHF) (n=11, survival 36%) and refractory vasoplegia (n=3, survival 0%). Inflammatory markers at VA-ECMO initiation were higher in patients with ALHF or vasoplegia;in these patients a higher rate of invasive fungal infections (10/14, 71% vs. 4/14, 29%;p=0.023) compared to the other patients was found. Conclusion(s) Survival on VA-ECMO in COVID-19 depends on VA-ECMO indication, which should be considered in further studies and clinical decisions making. Circulatory failure due to vasoplegia should be considered very carefully as indication for VA-ECMO. A high rate of mycotic infections mandates an intense microbiological workup of these patients and must be considered as an important differential diagnosis to CovHI.
adult; case report; case study; clinical article; conference abstract; coronavirus disease 2019; diagnosis; differential diagnosis; female; heart arrest; heart left ventricle failure; heart right ventricle failure; hospital discharge; human; hyperinflammation; inflammation; lung aspergillosis; lung embolism; male; middle aged; mycosis; nonhuman; practice guideline; pulmonary hypertension; retrospective study; sepsis; Sequential Organ Failure Assessment Score; shock; survival rate; systemic mycosis; university hospital; vasoplegia; veno-arterial ECMO; veno-venous ECMO; virus strain; wild type; noradrenalin
Texte intégral:
Disponible
Collection:
Bases de données des oragnisations internationales
Base de données:
EMBASE
Type d'étude:
Étude diagnostique
/
Étude observationnelle
/
Étude pronostique
Les sujets:
Variantes
langue:
Anglais
Revue:
Perfusion
Année:
2023
Type de document:
Article
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