PDF(Pubmed)
Abstract：
Background: Acute respiratory distress syndrome (ARDS) presents a significant challenge in critical care settings, characterized by compromised gas exchange, necessitating in the most severe cases interventions such as veno-venous extracorporeal membrane oxygenation (vv-ECMO) when conventional therapies fail. Critically ill ARDS patients on vv-ECMO may experience several complications. Limited data exist comparing complication rates between COVID-19 and non-COVID-19 ARDS patients undergoing vv-ECMO. This retrospective observational study aimed to assess and compare complications in these patient cohorts. Methods: We retrospectively analyzed the medical records of all patients receiving vv-ECMO for ARDS between March 2020 and March 2022. We recorded the baseline characteristics, the disease course and complication (barotrauma, bleeding, thrombosis) before and after ECMO cannulation, and clinical outcomes (mechanical ventilation and ECMO duration, intensive care unit, and hospital lengths of stay and mortalities). Data were compared between COVID-19 and non-COVID-19 patients. In addition, we compared survived and deceased patients. Results: Sixty-four patients were included. COVID-19 patients (n = 25) showed higher rates of pneumothorax (28% vs. 8%, p = 0.039) with subcutaneous emphysema (24% vs. 5%, p = 0.048) and longer non-invasive ventilation duration before vv-ECMO cannulation (2 [1; 4] vs. 0 [0; 1] days, p = <0.001), compared to non-COVID-19 patients (n = 39). However, complication rates and clinical outcomes post-vv-ECMO were similar between groups. Survival analysis revealed no significant differences in pre-vv-ECMO complications, but non-surviving patients had a trend toward higher complication rates and more pleural effusions post-vv-ECMO. Conclusions: COVID-19 patients on vv-ECMO exhibit higher pneumothorax rates with subcutaneous emphysema pre-cannulation; post-cannulation complications are comparable to non-COVID-19 patients.
摘要：
背景：急性呼吸窘迫综合征（ARDS）在重症监护环境中提出了重大挑战，以气体交换受损为特征，在最严重的情况下，当常规疗法失败时，需要采取干预措施，例如静脉-静脉体外膜氧合（vv-ECMO）。接受vv-ECMO治疗的危重ARDS患者可能会出现多种并发症。比较接受vv-ECMO的COVID-19和非COVID-19ARDS患者并发症发生率的数据有限。这项回顾性观察研究旨在评估和比较这些患者队列的并发症。方法：我们回顾性分析了2020年3月至2022年3月期间接受vv-ECMO治疗ARDS的所有患者的病历。我们记录了基线特征，病程和并发症(气压伤，出血,血栓形成)在ECMO插管之前和之后，和临床结果(机械通气和ECMO持续时间，重症监护室,以及住院时间和死亡率)。比较了COVID-19和非COVID-19患者的数据。此外,我们比较了存活和死亡的患者。结果：纳入64例患者。COVID-19患者（n=25）的气胸发生率更高（28%vs.8%,p=0.039）伴有皮下气肿（24%vs.5%,p=0.048）和vv-ECMO插管前更长的无创通气持续时间（2[1;4]vs.0[0;1]天,p=<0.001)，与非COVID-19患者相比（n=39）。然而,vv-ECMO治疗后的并发症发生率和临床结局在组间相似.生存分析显示vv-ECMO前并发症无显著差异，但未存活的患者在vv-ECMO后有更高的并发症发生率和更多的胸腔积液的趋势.结论：接受vv-ECMO的COVID-19患者插管前皮下气肿的气胸发生率更高；插管后并发症与非COVID-19患者相当。
