Dismal Survival in COVID-19 Patients Requiring ECMO as Rescue Therapy after Corticosteroid Failure

Journal of Personalized Medicine

Samar Souissi¹  Nicolas Deye¹  Thomas Lacoste-Palasset¹  Giulia Naim¹  Isabelle Malissin¹  Bruno Mégarbane¹  Lucie Fanet¹  Laetitia Sutterlin¹  Aymen M’Rad¹  Sebastian Voicu¹  Adrien Pepin-Lehaleur¹  Julia Busto²  Bruno Mourvillier²  Antoine Goury²  Vincent Legros³ 

[1] Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris-University, 75010 Paris, France;Medical Critical Care Department, Robert Debré University Hospital, 51100 Reims, France;Surgical Critical Care Department, Maison Blanche University Hospital, 51100 Reims, France;

关键词: ARDS;    COVID-19;    corticosteroid;    dexamethasone;    ECMO;    survival;   

DOI  :  10.3390/jpm11111238

来源: DOAJ

【 摘 要 】

(1) Background: COVID-19 may lead to refractory hypoxemia requiring venovenous extracorporeal membrane oxygenation (ECMO). Survival rate if ECMO is implemented as rescue therapy after corticosteroid failure is unknown. We aimed to investigate if ECMO implemented after failure of the full-recommended 10-day corticosteroid course can improve outcome. (2) Methods: We conducted a three-center cohort study including consecutive dexamethasone-treated COVID-19 patients requiring ECMO between 03/2020 and 05/2021. We compared survival at hospital discharge between patients implemented after (ECMO-after group) and before the end of the 10-day dexamethasone course (ECMO-before group). (3) Results: Forty patients (28M/12F; age, 57 years (51–62) (median (25th–75th percentiles)) were included, 28 (70%) in the ECMO-before and 12 (30%) in the ECMO-after group. In the ECMO-before group, 9/28 patients (32%) received the 6 mg/day dexamethasone regimen versus 12/12 (100%) in the ECMO-after group (p < 0.0001). The rest of the patients received an alternative dexamethasone regimen consisting of 20 mg/day during 5 days followed by 10 mg/day during 5 days. Patients in the ECMO-before group tended to be younger (57 years (51–59) versus 62 years (57–67), p = 0.053). In the ECMO-after group, no patient (0%) survived while 12 patients (43%) survived in the ECMO-before group (p = 0.007). (4) Conclusions: Survival is poor in COVID-19 patients requiring ECMO implemented after the full-recommended 10-day dexamethasone course. Since these patients may have developed a particularly severe presentation, new therapeutic strategies are urgently required.

【 授权许可】

Unknown