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Abstract：
Background: The efficacy of veno-venous extracorporeal membrane oxygenation (VV-ECMO) as rescue therapy for refractory COVID-19-related ARDS (C-ARDS) is still debated. We describe the cohort of C-ARDS patients treated with VV-ECMO at our ECMO center, focusing on factors that may affect in-hospital mortality and describing the time course of lung mechanics to assess prognosis. Methods: We performed a prospective observational study in the intensive care unit at the \"Città della Salute e della Scienza\" University Hospital in Turin, Italy, between March 2020 and December 2021. Indications and management of ECMO followed the Extracorporeal Life Support Organization (ELSO) guidelines. Results: The 60-day in-hospital mortality was particularly high (85.4%). Non-survivor patients were more frequently treated with non-invasive ventilatory support and steroids before ECMO (95.1% vs. 57.1%, p = 0.018 and 73.2% vs. 28.6%, p = 0.033, respectively), while hypertension was the only pre-ECMO factor independently associated with in-hospital mortality (HR: 2.06, 95%CI: 1.06-4.00). High rates of bleeding (85.4%) and superinfections (91.7%) were recorded during ECMO, likely affecting the overall length of ECMO (18 days, IQR: 10-24) and the hospital stay (32 days, IQR: 24-47). Static lung compliance was lower in non-survivors (p = 0.031) and differed over time (p = 0.049), decreasing by 48% compared to initial values in non-survivors. Conclusions: Our data suggest the importance of considering NIS among the common ECMO eligibility criteria and changes in lung compliance during ECMO as a prognostic marker.
摘要：
背景：静脉-静脉体外膜氧合（VV-ECMO）作为难治性COVID-19相关ARDS（C-ARDS）的抢救治疗的有效性仍存在争议。我们描述了在我们的ECMO中心接受VV-ECMO治疗的C-ARDS患者队列，重点关注可能影响院内死亡率的因素，并描述肺力学的时间过程以评估预后。方法：我们在都灵大学医院的重症监护病房进行了一项前瞻性观察研究，意大利,2020年3月至2021年12月。ECMO的适应症和管理遵循体外生命支持组织（ELSO）指南。结果：60天住院死亡率特别高（85.4％）。非幸存者患者在ECMO之前接受无创通气支持和类固醇治疗的频率更高（95.1％vs.57.1%,p=0.018和73.2%vs.28.6%,p=0.033，分别），而高血压是与住院死亡率独立相关的唯一ECMO前因素(HR:2.06,95CI:1.06~4.00).在ECMO期间记录了较高的出血率（85.4％）和超感染率（91.7％），可能影响ECMO的总长度(18天，IQR：10-24）和住院时间（32天，IQR：24-47）。非幸存者的静态肺顺应性较低（p=0.031），并且随着时间的推移而有所不同（p=0.049），与非幸存者的初始值相比，下降了48%。结论：我们的数据表明，在ECMO的通用合格标准中考虑NIS和ECMO期间肺顺应性的变化作为预后指标的重要性。
