COVID-19 と肺高血圧の患者における体外膜酸素化の結果: ELSO レジストリ分析
Raysa Morales-Demori1, Jamel Ortoleva2, Sukru Aras3
1Department of Pediatrics, Section of Critical Care, Baylor College of Medicine, Houston, TX.
Journal of cardiothoracic and vascular anesthesia
|September 3, 2025
まとめ
肺高血圧 (PH) の患者は,重度のCOVID-19で体外膜酸素化 (ECMO) を必要とするリスクプロファイルが高くなりました. 急性PHのアウトカムが非PHに似ている一方で,慢性PHでは死亡率と合併症率が高く,慎重に患者の選択が必要であった.
科学分野:
- クリティカル ケア 医療
- 心臓病科
- 感染症
背景:
- 重度のCOVID-19は急性または慢性肺高血圧 (PH) を引き起こす可能性があります.
- 身体外膜酸素化 (ECMO) は,重篤な呼吸器および心不全の生命維持手段である.
- ECMOで治療を受けたCOVID-19患者の結果に対するPHの影響は十分に定義されていません.
研究 の 目的:
- 重度のCOVID-19でECMOを受けている急性または慢性PHの患者の特徴を特定する.
- ECMOによるPHとPHのないCOVID-19患者のアウトカムと合併症率を比較する.
- ECMO治療を受けたPH患者の死亡率が高いという仮説を検証する.
主な方法:
- 身体外生命維持機構 (ELSO) の登録を遡って分析する.
- 深刻なCOVID-19患者 (2020-2021) のECMO支援による世界的なレジストリデータを含める.
- 急性PH (177),慢性PH (147) と非PH (7465) に分類する.
主要な成果:
- 総死亡率は有意な差異はなかった (No-PH: 52. 2%,急性-PH: 52. 0%,慢性-PH: 61. 9%,p=0. 07).
- 静脈 ECMOの使用率は急性PHで最高 (17. 5%) でした.
- 慢性PH患者では肝疾患 (26. 5%) と全体的な合併症 (84. 4%) が多く,急性PH患者では肢体不全症および神経学的合併症が多く見られた.
結論:
- ECMOによる急性または慢性PHのCOVID-19患者は,より高いリスクプロファイルを示します.
- 急性PH患者は非PH患者と同様の死亡率だったが,合併症は増加した.
- 慢性PHはより高い死亡率と合併症率と関連しており,最適な結果のために慎重に患者の選択の必要性を強調しています.
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