严重ARDSCOVID-19患者被拒绝有毒ECMO支持的结果:一个前性观察性比较研究
Aude Sylvestre1,2, Jean-Marie Forel1,2, Laura Textoris1,2
1Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France.
Journal of clinical medicine
|April 9, 2024
概括
对于严重的COVID-19ARDS,被拒绝毒性体外膜氧化 (VV-ECMO) 的患者的生存率较低,但许多人仍然康复. 这凸显了对VV-ECMO进行仔细的患者选择的重要性.
科学领域:
- 关键护理医学 关键护理医学
- 肺部病理学 肺部病理学
- 传染性疾病 传染性疾病
背景情况:
- 有限的数据存在于拒绝毒性体外膜氧化 (VV-ECMO) 的患者的结果,这些患者患有严重的COVID-19急性呼吸困扰综合征 (ARDS).
- 了解这个患者群体的结果对于临床决策和资源分配至关重要.
研究的目的:
- 为了比较严重的COVID-19 ARDS患者的90天生存率,这些患者被评估为VV-ECMO.
- 根据VV-ECMO是否有指示,没有指示或禁忌来分析结果.
主要方法:
- 对104名因严重的COVID-19 ARDS而被转诊给VV-ECMO的成年患者进行了回顾性分析.
- 患者被分为三个组:ECMO-指示,ECMO-未指示和ECMO-禁忌.
- 九十天的生存率在各组之间进行了比较.
主要成果:
- 在ECMO指示 (62.1%) 和ECMO未指示 (61.9%) 组中,90天生存率相似.
- 由于禁忌 (例如,晚年,长时间通风,高SOFA得分) 而被拒绝VV-ECMO的患者的90天生存率 (20.5%) 显着较低.
- 尽管被拒绝VV-ECMO,但50%的禁用患者在3个月内被送回家.
结论:
- VV-ECMO的禁忌与严重的COVID-19 ARDS的生存率显著降低有关.
- 很大一部分被拒绝VV-ECMO的患者,即使是因为禁忌,也可以恢复和出院.
- 这些发现强调了VV-ECMO在COVID-19 ARDS决策的复杂性以及对个性化预后的需求.
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