COVID-19に対する体外膜酸素化:国際体外生命維持機構のレジストリから進化する結果
Ryan P Barbaro1, Graeme MacLaren2, Philip S Boonstra3
1Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA.
Lancet (London, England)
|October 2, 2021
まとめ
2020年,体外膜酸素化 (ECMO) によるCOVID-19患者の死亡率は増加しました. 早期のECMO使用は生存率を向上させ,後の採用は死亡率を上昇させた.
科学分野:
- クリティカル ケア 医療
- 感染症
- 心肺のサポート
背景:
- COVID-19 パンデミックは,体外膜酸素化 (ECMO) の使用を増やすなど,重症治療における迅速な適応を必要とした.
- ECMOの使用の傾向,患者の選択,およびアウトカムを理解することは,重度のCOVID-19の管理に不可欠です.
- ECMOセンターの特徴は,パンデミック中の患者の結果に影響を与える可能性があります.
研究 の 目的:
- COVID-19患者の患者の選択,治療,結果,ECMOセンターの特徴を分析する.
- ECMOの開始時期とセンターの採用戦略を比較する.
- COVID-19 パンデミックの間,ECMOセンターの経験が生存に与える影響を評価する.
主な方法:
- 身体外生命支援機構の登録とCOVID-19補足の遡及的分析
- 3つのグループの比較:ECMOの早期採用者 (2020年5月1日前;2020年5月1日以降) と遅い採用者 (2020年5月1日以降).
- ECMO開始後90日間の入院死亡率のタイム・トゥ・イベント分析は,コックス比例リスクモデルを用いて行われました.
主要な成果:
- 2020年には349のセンターで4812人のCOVID-19患者がECMOを受診しました.
- 早期採用センターでの早期ECMO開始 (2020年5月1日前) は,遅い開始 (51. 9%) に比べて90日間の死亡率が低いことを示した.
- 遅い導入センターでは90日間の死亡率が高く (58. 9%) 早期導入センターと比較して調整されたリスクは高かった.
結論:
- 2020年にECMOを受けたCOVID-19患者の入院死亡率は悪化しました.
- 経験豊富なセンターでのECMOの早期開始は,より良い生存結果と関連していました.
- 発見は,重度のCOVID-19におけるECMOの使用に関する患者管理,臨床意思決定,政策開発に重要な洞察を提供します.
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