Outcomes of severe systemic rheumatic disease patients requiring extracorporeal membrane oxygenation

Annals of Intensive Care

Pascal Leprince¹  Guillaume Lebreton¹  Pierre Demondion¹  Juliette Chommeloux²  Guillaume Hékimian²  Pierre Bay²  Cyrielle Desnos²  Nicolas Bréchot²  Ania Nieszkowska²  Alain Combes³  Charles-Edouard Luyt³  Matthieu Schmidt³  Marc Pineton de Chambrun⁴  Fleur Cohen-Aubart⁵  Zahir Amoura⁵  Alexis Mathian⁵ 

[1] Service de Chirurgie Cardiothoracique, Hôpital La Pitié–Salpêtrière, Institut de Cardiologie, Sorbonne Université, APHP, Paris, France;Service de Médecine Intensive-Réanimation, Hôpital La Pitié–Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France;Service de Médecine Intensive-Réanimation, Hôpital La Pitié–Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France;Institut de Cardiométabolisme Et Nutrition (ICAN), Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France;Service de Médecine Intensive-Réanimation, Hôpital La Pitié–Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France;Service de Médecine Interne 2, Institut E3M, Sorbonne Université, Hôpital La Pitié–Salpêtrière, 47–83, Boulevard de L’Hôpital, 75651, Paris Cedex 13, France;Centre de Référence National Lupus Systémique, Syndrome Des Anticorps Anti-Phospholipides Et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France;Institut de Cardiométabolisme Et Nutrition (ICAN), Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France;Service de Médecine Interne 2, Institut E3M, Sorbonne Université, Hôpital La Pitié–Salpêtrière, 47–83, Boulevard de L’Hôpital, 75651, Paris Cedex 13, France;Centre de Référence National Lupus Systémique, Syndrome Des Anticorps Anti-Phospholipides Et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France;

关键词: Systemic rheumatic disease;    Extracorporeal membrane oxygenation;    Intensive care unit;    Vasculitis;    Systemic lupus erythematosus;    Connective tissue disease;    Acute respiratory distress syndrome;    Cardiogenic shock;   

DOI  :  10.1186/s13613-021-00819-3

来源: Springer

【 摘 要 】

BackgroundSystemic rheumatic diseases (SRDs) are a group of inflammatory disorders that can require intensive care unit (ICU) admission because of multiorgan involvement with end-organ failure(s). Critically ill SRD patients requiring extracorporeal membrane oxygenation (ECMO) were studied to gain insight into their characteristics and outcomes.MethodsThis French monocenter, retrospective study included all SRD patients requiring venovenous (VV)- or venoarterial (VA)-ECMO admitted to a 26-bed ECMO-dedicated ICU from January 2006 to February 2020. The primary endpoint was in-hospital mortality.ResultsNinety patients (male/female ratio: 0.5; mean age at admission: 41.6 ± 15.2 years) admitted to the ICU received VA/VV-ECMO, respectively, for an SRD-related flare (n = 69, n = 38/31) or infection (n = 21, n = 10/11). SRD was diagnosed in-ICU for 31 (34.4%) patients. In-ICU and in-hospital mortality rates were 48.9 and 51.1%, respectively. Nine patients were bridged to cardiac (n = 5) or lung transplantation (n = 4), or left ventricular assist device (n = 2). The Cox multivariable model retained the following independent predictors of in-hospital mortality: in-ICU SRD diagnosis, day-0 Simplified Acute Physiology Score (SAPS) II score ≥ 70 and arterial lactate ≥ 7.5 mmol/L for VA-ECMO–treated patients; diagnosis other than vasculitis, day-0 SAPS II score ≥ 70, ventilator-associated pneumonia and arterial lactate ≥ 7.5 mmol/L for VV-ECMO–treated patients.ConclusionsECMO support is a relevant rescue technique for critically ill SRD patients, with 49% survival at hospital discharge. Vasculitis was independently associated with favorable outcomes of VV-ECMO–treated patients. Further studies are needed to specify the role of ECMO for SRD patients.

【 授权许可】

CC BY