Cargando…

Clinical Characteristics, Complications and Outcomes of Patients with Severe Acute Respiratory Distress Syndrome Related to COVID-19 or Influenza Requiring Extracorporeal Membrane Oxygenation—A Retrospective Cohort Study

Extracorporeal membrane oxygenation (ECMO) represents a viable therapy option for patients with refractory acute respiratory distress syndrome (ARDS). Currently, veno-venous (vv) ECMO is frequently used in patients suffering from coronavirus disease 2019 (COVID-19). VV-ECMO was also frequently utili...

Descripción completa

Detalles Bibliográficos
Autores principales: Roedl, Kevin, Kahn, Ahmel, Jarczak, Dominik, Fischer, Marlene, Boenisch, Olaf, de Heer, Geraldine, Burdelski, Christoph, Frings, Daniel, Sensen, Barbara, Nierhaus, Axel, Braune, Stephan, Yildirim, Yalin, Bernhardt, Alexander, Reichenspurner, Hermann, Kluge, Stefan, Wichmann, Dominic
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8619058/
https://www.ncbi.nlm.nih.gov/pubmed/34830721
http://dx.doi.org/10.3390/jcm10225440
_version_ 1784604897737441280
author Roedl, Kevin
Kahn, Ahmel
Jarczak, Dominik
Fischer, Marlene
Boenisch, Olaf
de Heer, Geraldine
Burdelski, Christoph
Frings, Daniel
Sensen, Barbara
Nierhaus, Axel
Braune, Stephan
Yildirim, Yalin
Bernhardt, Alexander
Reichenspurner, Hermann
Kluge, Stefan
Wichmann, Dominic
author_facet Roedl, Kevin
Kahn, Ahmel
Jarczak, Dominik
Fischer, Marlene
Boenisch, Olaf
de Heer, Geraldine
Burdelski, Christoph
Frings, Daniel
Sensen, Barbara
Nierhaus, Axel
Braune, Stephan
Yildirim, Yalin
Bernhardt, Alexander
Reichenspurner, Hermann
Kluge, Stefan
Wichmann, Dominic
author_sort Roedl, Kevin
collection PubMed
description Extracorporeal membrane oxygenation (ECMO) represents a viable therapy option for patients with refractory acute respiratory distress syndrome (ARDS). Currently, veno-venous (vv) ECMO is frequently used in patients suffering from coronavirus disease 2019 (COVID-19). VV-ECMO was also frequently utilised during the influenza pandemic and experience with this complex and invasive treatment has increased worldwide since. However, data on comparison of clinical characteristics and outcome of patients with COVID-19 and influenza-related severe ARDS treated with vv-ECMO are scarce. This is a retrospective analysis of all consecutive patients treated with vv/(veno-arterial)va-ECMO between January 2009 and January 2021 at the University Medical Centre Hamburg-Eppendorf in Germany. All patients with confirmed COVID-19 or influenza were included. Patient characteristics, parameters related to ICU and vv/va-ECMO as well as clinical outcomes were compared. Mortality was assessed up to 90 days after vv/va-ECMO initiation. Overall, 113 patients were included, 52 (46%) with COVID-19 and 61 (54%) with influenza-related ARDS. Median age of patients with COVID-19 and influenza was 58 (IQR 53–64) and 52 (39–58) years (p < 0.001), 35% and 31% (p = 0.695) were female, respectively. Charlson Comorbidity Index was 3 (1–5) and 2 (0–5) points in the two groups (p = 0.309). Median SAPS II score pre-ECMO was 27 (24–36) vs. 32 (28–41) points (p = 0.009), and SOFA score was 13 (11–14) vs. 12 (8–15) points (p = 0.853), respectively. Median P/F ratio pre-ECMO was 64 (46–78) and 73 (56–104) (p = 0.089); pH was 7.20 (7.16–7.29) and 7.26 (7.18–7.33) (p = 0.166). Median days on vv/va-ECMO were 17 (7–27) and 11 (7–20) (p = 0.295), respectively. Seventy-one percent and sixty-nine percent had renal replacement therapy (p = 0.790). Ninety-four percent of patients with COVID-19 and seventy-seven percent with influenza experienced vv/va-ECMO-associated bleeding events (p = 0.004). Thirty-four percent and fifty-five percent were successfully weaned from ECMO (p = 0.025). Ninety-day mortality was 65% and 57% in patients with COVID-19 and influenza, respectively (p = 0.156). Median length of ICU stay was 24 (13–44) and 28 (16–14) days (p = 0.470), respectively. Despite similar disease severity, the use of vv/va-ECMO in ARDS related to COVID-19 and influenza resulted in similar outcomes at 90 days. A significant higher rate of bleeding complications and thrombosis was observed in patients with COVID-19.
format Online
Article
Text
id pubmed-8619058
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-86190582021-11-27 Clinical Characteristics, Complications and Outcomes of Patients with Severe Acute Respiratory Distress Syndrome Related to COVID-19 or Influenza Requiring Extracorporeal Membrane Oxygenation—A Retrospective Cohort Study Roedl, Kevin Kahn, Ahmel Jarczak, Dominik Fischer, Marlene Boenisch, Olaf de Heer, Geraldine Burdelski, Christoph Frings, Daniel Sensen, Barbara Nierhaus, Axel Braune, Stephan Yildirim, Yalin Bernhardt, Alexander Reichenspurner, Hermann Kluge, Stefan Wichmann, Dominic J Clin Med Article Extracorporeal membrane oxygenation (ECMO) represents a viable therapy option for patients with refractory acute respiratory distress syndrome (ARDS). Currently, veno-venous (vv) ECMO is frequently used in patients suffering from coronavirus disease 2019 (COVID-19). VV-ECMO was also frequently utilised during the influenza pandemic and experience with this complex and invasive treatment has increased worldwide since. However, data on comparison of clinical characteristics and outcome of patients with COVID-19 and influenza-related severe ARDS treated with vv-ECMO are scarce. This is a retrospective analysis of all consecutive patients treated with vv/(veno-arterial)va-ECMO between January 2009 and January 2021 at the University Medical Centre Hamburg-Eppendorf in Germany. All patients with confirmed COVID-19 or influenza were included. Patient characteristics, parameters related to ICU and vv/va-ECMO as well as clinical outcomes were compared. Mortality was assessed up to 90 days after vv/va-ECMO initiation. Overall, 113 patients were included, 52 (46%) with COVID-19 and 61 (54%) with influenza-related ARDS. Median age of patients with COVID-19 and influenza was 58 (IQR 53–64) and 52 (39–58) years (p < 0.001), 35% and 31% (p = 0.695) were female, respectively. Charlson Comorbidity Index was 3 (1–5) and 2 (0–5) points in the two groups (p = 0.309). Median SAPS II score pre-ECMO was 27 (24–36) vs. 32 (28–41) points (p = 0.009), and SOFA score was 13 (11–14) vs. 12 (8–15) points (p = 0.853), respectively. Median P/F ratio pre-ECMO was 64 (46–78) and 73 (56–104) (p = 0.089); pH was 7.20 (7.16–7.29) and 7.26 (7.18–7.33) (p = 0.166). Median days on vv/va-ECMO were 17 (7–27) and 11 (7–20) (p = 0.295), respectively. Seventy-one percent and sixty-nine percent had renal replacement therapy (p = 0.790). Ninety-four percent of patients with COVID-19 and seventy-seven percent with influenza experienced vv/va-ECMO-associated bleeding events (p = 0.004). Thirty-four percent and fifty-five percent were successfully weaned from ECMO (p = 0.025). Ninety-day mortality was 65% and 57% in patients with COVID-19 and influenza, respectively (p = 0.156). Median length of ICU stay was 24 (13–44) and 28 (16–14) days (p = 0.470), respectively. Despite similar disease severity, the use of vv/va-ECMO in ARDS related to COVID-19 and influenza resulted in similar outcomes at 90 days. A significant higher rate of bleeding complications and thrombosis was observed in patients with COVID-19. MDPI 2021-11-21 /pmc/articles/PMC8619058/ /pubmed/34830721 http://dx.doi.org/10.3390/jcm10225440 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Roedl, Kevin
Kahn, Ahmel
Jarczak, Dominik
Fischer, Marlene
Boenisch, Olaf
de Heer, Geraldine
Burdelski, Christoph
Frings, Daniel
Sensen, Barbara
Nierhaus, Axel
Braune, Stephan
Yildirim, Yalin
Bernhardt, Alexander
Reichenspurner, Hermann
Kluge, Stefan
Wichmann, Dominic
Clinical Characteristics, Complications and Outcomes of Patients with Severe Acute Respiratory Distress Syndrome Related to COVID-19 or Influenza Requiring Extracorporeal Membrane Oxygenation—A Retrospective Cohort Study
title Clinical Characteristics, Complications and Outcomes of Patients with Severe Acute Respiratory Distress Syndrome Related to COVID-19 or Influenza Requiring Extracorporeal Membrane Oxygenation—A Retrospective Cohort Study
title_full Clinical Characteristics, Complications and Outcomes of Patients with Severe Acute Respiratory Distress Syndrome Related to COVID-19 or Influenza Requiring Extracorporeal Membrane Oxygenation—A Retrospective Cohort Study
title_fullStr Clinical Characteristics, Complications and Outcomes of Patients with Severe Acute Respiratory Distress Syndrome Related to COVID-19 or Influenza Requiring Extracorporeal Membrane Oxygenation—A Retrospective Cohort Study
title_full_unstemmed Clinical Characteristics, Complications and Outcomes of Patients with Severe Acute Respiratory Distress Syndrome Related to COVID-19 or Influenza Requiring Extracorporeal Membrane Oxygenation—A Retrospective Cohort Study
title_short Clinical Characteristics, Complications and Outcomes of Patients with Severe Acute Respiratory Distress Syndrome Related to COVID-19 or Influenza Requiring Extracorporeal Membrane Oxygenation—A Retrospective Cohort Study
title_sort clinical characteristics, complications and outcomes of patients with severe acute respiratory distress syndrome related to covid-19 or influenza requiring extracorporeal membrane oxygenation—a retrospective cohort study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8619058/
https://www.ncbi.nlm.nih.gov/pubmed/34830721
http://dx.doi.org/10.3390/jcm10225440
work_keys_str_mv AT roedlkevin clinicalcharacteristicscomplicationsandoutcomesofpatientswithsevereacuterespiratorydistresssyndromerelatedtocovid19orinfluenzarequiringextracorporealmembraneoxygenationaretrospectivecohortstudy
AT kahnahmel clinicalcharacteristicscomplicationsandoutcomesofpatientswithsevereacuterespiratorydistresssyndromerelatedtocovid19orinfluenzarequiringextracorporealmembraneoxygenationaretrospectivecohortstudy
AT jarczakdominik clinicalcharacteristicscomplicationsandoutcomesofpatientswithsevereacuterespiratorydistresssyndromerelatedtocovid19orinfluenzarequiringextracorporealmembraneoxygenationaretrospectivecohortstudy
AT fischermarlene clinicalcharacteristicscomplicationsandoutcomesofpatientswithsevereacuterespiratorydistresssyndromerelatedtocovid19orinfluenzarequiringextracorporealmembraneoxygenationaretrospectivecohortstudy
AT boenischolaf clinicalcharacteristicscomplicationsandoutcomesofpatientswithsevereacuterespiratorydistresssyndromerelatedtocovid19orinfluenzarequiringextracorporealmembraneoxygenationaretrospectivecohortstudy
AT deheergeraldine clinicalcharacteristicscomplicationsandoutcomesofpatientswithsevereacuterespiratorydistresssyndromerelatedtocovid19orinfluenzarequiringextracorporealmembraneoxygenationaretrospectivecohortstudy
AT burdelskichristoph clinicalcharacteristicscomplicationsandoutcomesofpatientswithsevereacuterespiratorydistresssyndromerelatedtocovid19orinfluenzarequiringextracorporealmembraneoxygenationaretrospectivecohortstudy
AT fringsdaniel clinicalcharacteristicscomplicationsandoutcomesofpatientswithsevereacuterespiratorydistresssyndromerelatedtocovid19orinfluenzarequiringextracorporealmembraneoxygenationaretrospectivecohortstudy
AT sensenbarbara clinicalcharacteristicscomplicationsandoutcomesofpatientswithsevereacuterespiratorydistresssyndromerelatedtocovid19orinfluenzarequiringextracorporealmembraneoxygenationaretrospectivecohortstudy
AT nierhausaxel clinicalcharacteristicscomplicationsandoutcomesofpatientswithsevereacuterespiratorydistresssyndromerelatedtocovid19orinfluenzarequiringextracorporealmembraneoxygenationaretrospectivecohortstudy
AT braunestephan clinicalcharacteristicscomplicationsandoutcomesofpatientswithsevereacuterespiratorydistresssyndromerelatedtocovid19orinfluenzarequiringextracorporealmembraneoxygenationaretrospectivecohortstudy
AT yildirimyalin clinicalcharacteristicscomplicationsandoutcomesofpatientswithsevereacuterespiratorydistresssyndromerelatedtocovid19orinfluenzarequiringextracorporealmembraneoxygenationaretrospectivecohortstudy
AT bernhardtalexander clinicalcharacteristicscomplicationsandoutcomesofpatientswithsevereacuterespiratorydistresssyndromerelatedtocovid19orinfluenzarequiringextracorporealmembraneoxygenationaretrospectivecohortstudy
AT reichenspurnerhermann clinicalcharacteristicscomplicationsandoutcomesofpatientswithsevereacuterespiratorydistresssyndromerelatedtocovid19orinfluenzarequiringextracorporealmembraneoxygenationaretrospectivecohortstudy
AT klugestefan clinicalcharacteristicscomplicationsandoutcomesofpatientswithsevereacuterespiratorydistresssyndromerelatedtocovid19orinfluenzarequiringextracorporealmembraneoxygenationaretrospectivecohortstudy
AT wichmanndominic clinicalcharacteristicscomplicationsandoutcomesofpatientswithsevereacuterespiratorydistresssyndromerelatedtocovid19orinfluenzarequiringextracorporealmembraneoxygenationaretrospectivecohortstudy