单位：[1]Chinese Acad Med Sci, Peking Union Med Coll Hosp, State Key Lab Complex Severe & Rare Dis, Dept Crit Care Med, Beijing, Peoples R China[2]Natl Hlth Commiss Peoples Republ China, Dept Med Adm, Beijing, Peoples R China[3]Chinese Acad Med Sci, Peking Union Med Coll Hosp, State Key Lab Complex Severe & Rare Dis, Dept Med Crit Care Med, Beijing, Peoples R China[4]Southeast Univ, Sch Med, Zhongda Hosp, Dept Crit Care Med, Nanjing, Peoples R China[5]Sun Yat Sen Univ, Affiliated Hosp 1, Dept Crit Care Med, Guangzhou, Peoples R China中山大学附属第一医院[6]Shanghai Jiao Tong Univ, Med Coll, Ruijin Hosp, Dept Crit Care Med, Shanghai, Peoples R China[7]Sichuan Univ, West China Hosp, Dept Crit Care Med, Chengdu, Peoples R China四川大学华西医院[8]Capital Med Univ, Beijing Chao Yang Hosp, Beijing Inst Resp Med, Dept Resp & Crit Care Med, Beijing, Peoples R China北京朝阳医院[9]Wuhan Univ, Zhongnan Hosp, Dept Crit Care Med, Wuhan, Peoples R China[10]Huazhong Univ Sci & Technol, Tongji Med Coll, Union Hosp, Dept Crit Care Med, Wuhan, Peoples R China华中科技大学同济医学院附属协和医院[11]Northern Jiangsu Peoples Hosp, Dept Crit Care Med, Yangzhou, Jiangsu, Peoples R China[12]Huazhong Univ Sci & Technol,Tongji Med Coll,Tongji Hosp,Dept Crit Care Med,Wuhan,Peoples R China华中科技大学同济医学院附属同济医院急诊医学科[13]Sichuan Acad Med Sci & Sichuan Prov Peoples Hosp, Dept Crit Care Med, Chongqing, Peoples R China四川省人民医院[14]China Japan Friendship Hosp, Dept Resp & Crit Care Med, Beijing, Peoples R China[15]China Med Univ, Hosp 1, Dept Crit Care Med, Shenyang, Peoples R China[16]Wuhan Jinyintan Hosp, Dept Thorac Surg, Wuhan, Peoples R China[17]Second Hosp Jilin Univ, Dept Emergency & Crit Care Med, Changchun, Peoples R China[18]Fudan Univ, Huashan Hosp, Dept Pulm & Crit Care Med, Shanghai, Peoples R China[19]Capital Med Univ, Xuanwu Hosp, Dept Crit Care Med, Beijing, Peoples R China首都医科大学宣武医院[20]Wuhan Pulm Hosp, Dept Crit Care Med, Wuhan, Peoples R China[21]Fudan Univ, Zhongshan Hosp, Dept Cardiovasc Surg, Shanghai, Peoples R China[22]Chinese Acad Med Sci, Peking Union Med Coll Hosp, State Key Lab Complex Severe & Rare Dis, Dept Cardiol, Beijing, Peoples R China
Background: Extracorporeal membrane oxygenation (ECMO) might benefit critically ill COVID-19 patients. But the considerations besides indications guiding ECMO initiation under extreme pressure during the COVID-19 epidemic was not clear. We aimed to analyze the clinical characteristics and in-hospital mortality of severe critically ill COVID-19 patients supported with ECMO and without ECMO, exploring potential parameters for guiding the initiation during the COVID-19 epidemic.</p> Methods: Observational cohort study of all the critically ill patients indicated for ECMO support from January 1 to May 1, 2020, in all 62 authorized hospitals in Wuhan, China.</p> Results: Among the 168 patients enrolled, 74 patients actually received ECMO support and 94 not were analyzed. The in-hospital mortality of the ECMO supported patients was significantly lower than non-ECMO ones (71.6 vs. 85.1%, P = 0.033), but the role of ECMO was affected by patients' age (Logistic regression OR 0.62, P = 0.24). As for the ECMO patients, the median age was 58 (47-66) years old and 62.2% (46/74) were male. The 28-day, 60-day, and 90-day mortality of these ECMO supported patients were 32.4, 68.9, and 74.3% respectively. Patients survived to discharge were younger (49 vs. 62 years, P = 0.042), demonstrated higher lymphocyte count (886 vs. 638 cells/uL, P = 0.022), and better CO2 removal (PaCO2 immediately after ECMO initiation 39.7 vs. 46.9 mmHg, P = 0.041). Age was an independent risk factor for in-hospital mortality of the ECMO supported patients, and a cutoff age of 51 years enabled prediction of in-hospital mortality with a sensitivity of 84.3% and specificity of 55%. The surviving ECMO supported patients had longer ICU and hospital stays (26 vs. 18 days, P = 0.018; 49 vs. 29 days, P = 0.001 respectively), and ECMO procedure was widely carried out after the supplement of medical resources after February 15 (67.6%, 50/74).</p> Conclusions: ECMO might be a benefit for severe critically ill COVID-19 patients at the early stage of epidemic, although the in-hospital mortality was still high. To initiate ECMO therapy under tremendous pressure, patients' age, lymphocyte count, and adequacy of medical resources should be fully considered.</p>
基金：
National Key R&D Program of China [2020YFC0861000]; CAMS Innovation Fund for Medical Sciences (CIFMS) [2020-I2M-CoV19-001]; Beijing Municipal Natural Science Foundation [M21019]; CMB Open Competition Program [20-381]
第一作者单位：[1]Chinese Acad Med Sci, Peking Union Med Coll Hosp, State Key Lab Complex Severe & Rare Dis, Dept Crit Care Med, Beijing, Peoples R China
通讯作者：
推荐引用方式(GB/T 7714)：
Cheng Wei,Ma Xu-Dong,Su Long-Xiang,et al.Retrospective Study of Critically Ill COVID-19 Patients With and Without Extracorporeal Membrane Oxygenation Support in Wuhan, China[J].FRONTIERS IN MEDICINE.2021,8:doi:10.3389/fmed.2021.659793.
APA：
Cheng, Wei,Ma, Xu-Dong,Su, Long-Xiang,Long, Yun,Liu, Da-Wei...&Zhang, Shu-Yang.(2021).Retrospective Study of Critically Ill COVID-19 Patients With and Without Extracorporeal Membrane Oxygenation Support in Wuhan, China.FRONTIERS IN MEDICINE,8,
MLA：
Cheng, Wei,et al."Retrospective Study of Critically Ill COVID-19 Patients With and Without Extracorporeal Membrane Oxygenation Support in Wuhan, China".FRONTIERS IN MEDICINE 8.(2021)
