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Article Dans Une Revue Anesthesiology Année : 2022

Extracorporeal Membrane Oxygenation for Respiratory Failure Related to COVID-19: A Nationwide Cohort Study

1 CIC - Centre d'Investigation Clinique [Rennes]
2 NuMeCan - Nutrition, Métabolismes et Cancer
3 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
4 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
5 CHU Pitié-Salpêtrière [AP-HP]
6 LVTS (UMR_S_1148 / U1148) - Laboratoire de Recherche Vasculaire Translationnelle
7 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
8 NanoRegMed - Nanomédecine Régénérative
9 FMTS - Fédération de Médecine Translationnelle de Strasbourg
10 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
11 Nouvel Hôpital Civil de Strasbourg
12 IMRB - Institut Mondor de Recherche Biomédicale
13 Hôpital Henri Mondor
14 TIMONE - Hôpital de la Timone [CHU - APHM]
15 Hôpital Bicêtre
16 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
17 Service de Cardiologie [CHRU Nancy]
18 CHR Metz-Thionville - Centre hospitalier régional Metz-Thionville
19 CHU Dijon
20 CHU Angers - Centre Hospitalier Universitaire d'Angers
21 MITOVASC - MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale
22 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
23 Hôpital Louis Pradel [CHU - HCL]
24 Biologie des maladies cardiovasculaires = Biology of Cardiovascular Diseases
25 CHU Bordeaux
26 HPPIT - Hypertension pulmonaire : physiopathologie et innovation thérapeutique
27 Hôpital Marie-Lannelongue
28 hpsj - Groupe Hospitalier Paris Saint-Joseph
29 Hôpital universitaire Robert Debré [Reims]
30 URCA - Université de Reims Champagne-Ardenne
31 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
32 CHU Montpellier
33 Franco-czech Laboratory for clinical research on obesity
34 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
35 CHU Rouen
36 IMM - Institut Mutualiste de Montsouris
37 Centre hospitalier Félix-Guyon [Saint-Denis, La Réunion]
38 CHU de Poitiers - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
39 UC San Francisco - University of California [San Francisco]
40 CIC 1425 - Centre d'investigation Clinique [CHU Bichat] - Épidémiologie clinique
41 LTSI - Laboratoire Traitement du Signal et de l'Image
42 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
Astrid Bertier
  • Fonction : Auteur
Pierre-Grégoire Guinot
Thomas Clavier
  • Fonction : Auteur

Résumé

BACKGROUND: Despite expanding use, knowledge on extracorporeal membrane oxygenation support during the COVID-19 pandemic remains limited. The objective was to report characteristics, management, and outcomes of patients receiving extracorporeal membrane oxygenation with a diagnosis of COVID-19 in France and to identify pre-extracorporeal membrane oxygenation factors associated with in-hospital mortality. A hypothesis of similar mortality rates and risk factors for COVID-19 and non-COVID-19 patients on venovenous extracorporeal membrane oxygenation was made. METHODS: The Extracorporeal Membrane Oxygenation for Respiratory Failure and/or Heart failure related to Severe Acute Respiratory Syndrome-Coronavirus 2 (ECMOSARS) registry included COVID-19 patients supported by extracorporeal membrane oxygenation in France. This study analyzed patients included in this registry up to October 25, 2020, and supported by venovenous extracorporeal membrane oxygenation for respiratory failure with a minimum follow-up of 28 days after cannulation. The primary outcome was in-hospital mortality. Risk factors for in-hospital mortality were analyzed. RESULTS: Among 494 extracorporeal membrane oxygenation patients included in the registry, 429 were initially supported by venovenous extracorporeal membrane oxygenation and followed for at least 28 days. The median (interquartile range) age was 54 yr (46 to 60 yr), and 338 of 429 (79%) were men. Management before extracorporeal membrane oxygenation cannulation included prone positioning for 411 of 429 (96%), neuromuscular blockage for 419 of 427 (98%), and NO for 161 of 401 (40%). A total of 192 of 429 (45%) patients were cannulated by a mobile extracorporeal membrane oxygenation unit. In-hospital mortality was 219 of 429 (51%), with a median follow-up of 49 days (33 to 70 days). Among pre-extracorporeal membrane oxygenation modifiable exposure variables, neuromuscular blockage use (hazard ratio, 0.286; 95% CI, 0.101 to 0.81) and duration of ventilation (more than 7 days compared to less than 2 days; hazard ratio, 1.74; 95% CI, 1.07 to 2.83) were independently associated with in-hospital mortality. Both age (per 10-yr increase; hazard ratio, 1.27; 95% CI, 1.07 to 1.50) and total bilirubin at cannulation (6.0 mg/dl or more compared to less than 1.2 mg/dl; hazard ratio, 2.65; 95% CI, 1.09 to 6.5) were confounders significantly associated with in-hospital mortality. CONCLUSIONS: In-hospital mortality was higher than recently reported, but nearly half of the patients survived. A high proportion of patients were cannulated by a mobile extracorporeal membrane oxygenation unit. Several factors associated with mortality were identified. Venovenous extracorporeal membrane oxygenation support should be considered early within the first week of mechanical ventilation initiation.
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Dates et versions

hal-03631467 , version 1 (08-11-2022)

Identifiants

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Nicolas Nesseler, Guillaume Fadel, Alexandre Mansour, Marylou Para, Pierre-Emmanuel Falcoz, et al.. Extracorporeal Membrane Oxygenation for Respiratory Failure Related to COVID-19: A Nationwide Cohort Study. Anesthesiology, 2022, 136 (5), pp.732-748. ⟨10.1097/ALN.0000000000004168⟩. ⟨hal-03631467⟩
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