Extracorporeal membrane oxygenation support for SARS-CoV-2: a multi-centered, prospective, observational study in critically ill 92 patients in Saudi Arabia

European Journal of Medical Research

Ahmad A. Albagshi¹  Zulfa M. Alhejy¹  Saad Alhumaid¹  Javed Muhammad²  Sana Almahmoud³  Amjad Khan⁴  Hassan Al-Helal⁵  Sadiq A. Al Salman⁶  Kuldeep Dhama⁷  Maha Al-Mozaini⁸  Jaffar A. Al-Tawfiq⁹  Tarek Sulaiman^1,10  Jalal Alali^1,11  Ali J. Alhaddad^1,12  Header A. Alghazal^1,13  Ali A. Rabaan^1,14  Abbas Al Mutair^1,15 

[1] Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, 31982, Al-Ahsa, Saudi Arabia;Department of Microbiology, The University of Haripur, 22620, Haripur, Khyber Pakhtunkhwa, Pakistan;Department of Nursing Education, College of Nursing, Imam Abdulrahman Bin Faisal University, King Faisal Road, Dammam, Saudi Arabia;Department of Public Health/Nutrition, The University of Haripur, Haripur, Pakistan;Division of Laboratory, Medical Microbiology Department, Maternity and Children Hospital, Al-Ahsa, Saudi Arabia;Division of Neurology, Internal Medicine Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia;Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, 243122, Bareilly, Uttar Pradesh, India;Immunocompromised Host Research Unit, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Center, 11211, Riyadh, Saudi Arabia;Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia;Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA;Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA;Infectious Diseases Section, Medical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia;Internal Medicine Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia;Microbiology Department, Omran General Hospital, Al-Ahsa, Saudi Arabia;Microbiology Laboratory, Prince Saud Bin Jalawi Hospital, Al-Ahsa, Saudi Arabia;Molecular Diagnostics Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia;Department of Public Health and Nutrition, The University of Haripur, 22610, Haripur, Pakistan;Research Center, Almoosa Specialist Hospital, Al-Ahsa, Saudi Arabia;College of Nursing, Princess Norah Bint Abdul Rahman University, Riyadh, Saudi Arabia;School of Nursing, Wollongong University, Wollongong, Australia;

关键词: Clinical;    COVID-19;    Extracorporeal;    Membrane;    Oxygenation;    ECMO;    Mortality;    Outcomes;    SARS-CoV-2;    Saudi Arabia;   

DOI  :  10.1186/s40001-021-00618-3

来源: Springer

【 摘 要 】

BackgroundExtracorporeal membrane oxygenation (ECMO) has been used as a rescue strategy in patients with severe with acute respiratory distress syndrome (ARDS) due to SARS-CoV-2 infection, but there has been little evidence of its efficacy.ObjectivesTo describe the effect of ECMO rescue therapy on patient-important outcomes in patients with severe SARS-CoV-2.MethodsA case series study was conducted for the laboratory-confirmed SARS-CoV-2 patients who were admitted to the ICUs of 22 Saudi hospitals, between March 1, 2020, and October 30, 2020, by reviewing patient’s medical records prospectively.ResultsECMO use was associated with higher in-hospital mortality (40.2% vs. 48.9%; p = 0.000); lower COVID-19 virological cure (41.3% vs 14.1%, p = 0.000); and longer hospitalization (20.2 days vs 29.1 days; p = 0.000), ICU stay (12.6 vs 26 days; p = 0.000) and mechanical ventilation use (14.2 days vs 22.4 days; p = 0.000) compared to non-ECMO group. Also, there was a high number of patients with septic shock (19.6%) and multiple organ failure (10.9%); and more complications occurred at any time during hospitalization [pneumothorax (5% vs 29.3%, p = 0.000), bleeding requiring blood transfusion (7.1% vs 38%, p = 0.000), pulmonary embolism (6.4% vs 15.2%, p = 0.016), and gastrointestinal bleeding (3.3% vs 8.7%, p = 0.017)] in the ECMO group. However, PaO2 was significantly higher in the 72-h post-ECMO initiation group and PCO2 was significantly lower in the 72-h post-ECMO start group than those in the 12-h pre-ECMO group (62.9 vs. 70 mmHg, p = 0.002 and 61.8 vs. 51 mmHg, p = 0.042, respectively).ConclusionFollowing the use of ECMO, the mortality rate of patients and length of ICU and hospital stay were not improved. However, these findings need to be carefully interpreted, as most of our cohort patients were relatively old and had multiple severe comorbidities. Future randomized trials, although challenging to conduct, are highly needed to confirm or dispute reported observations.

【 授权许可】

CC BY