Dismal Survival in COVID-19 Patients Requiring ECMO as Rescue Therapy after Corticosteroid Failure
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Purposes
2.2. Study Population
2.3. Ventilation and ECMO Management in the ICU
2.4. Data Collection
2.5. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Dexamethasone and Other Immunomodulatory Treatments
3.3. ECMO Treatment and Correlates of Survival
3.4. Time-Course of the PaO2/FiO2 Ratio in the ECMO-after Group
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Parameters * | All Patients (N = 40) | ECMO before/during the 10-Day Dexamethasone Course (N = 28) | ECMO after the 10-Day Dexamethasone Course (N = 12) | p-Value |
---|---|---|---|---|
Age (years) | 57 (51–62) | 57 (51–59) | 62 (57–67) | 0.053 |
Male gender, N (%) | 30 (75) | 22 (79) | 8 (67) | 0.46 |
Body mass index (kg/m2) | 31 (28–35) | 32 (28–35) | 30 (27–32) | 0.38 |
History of hypertension, N (%) | 16 (40) | 9 (32) | 7 (58) | 0.17 |
Diabetes mellitus, N (%) | 16 (40) | 9 (32) | 7 (58) | 0.17 |
Ischemic heart disease, N (%) | 3 (8) | 2 (7) | 1 (8) | 1.0 |
History of heart failure, N (%) | 1 (3) | 1 (4) | 0 (0) | 1.0 |
Long-term anticoagulation, N (%) | 2 (5) | 1 (4) | 1 (8) | 0.52 |
Long-term aspirin treatment, N (%) | 6 (15) | 3 (11) | 3 (25) | 0.34 |
PaO2/FiO2 (mm Hg) | 84 (71–136) | 79 (61–111) | 93 (76–158) | 0.36 |
SOFA score on admission | 8 (4–12) | 9 (6–13) | 5 (3–6) | 0.02 |
Parameters * | All Patients (N = 40) | ECMO before/during the 10-Day Dexamethasone Course (N = 28) | ECMO after the 10-Day Dexamethasone Course (N = 12) | p-Value |
---|---|---|---|---|
Serum creatinine (µmol/L) | 116 (64–265) | 152 (71–283) | 92 (61–139) | 0.14 |
Serum alanine aminotransferase (IU/L) | 38 (24–80) | 38 (26–66) | 44 (22–92) | 0.95 |
Blood lactate (mmol/L) | 1.5 (1.2–2.8) | 1.5 (1.3–2.9) | 1.6 (1.2–2.2) | 0.81 |
C-reactive protein (mg/L) | 155 (94–264) | 155 (97–222) | 177 (56–306) | 0.83 |
Procalcitonin (µg/L) | 1.40 (0.2–3.14) | 1.25 (0.62–2.85) | 2.19 (0.19–5.49) | 0.95 |
Fibrinogen (g/L) | 6.0 (4.8–7.6) | 5.8 (4.4–7.1) | 6.3 (5.4–8.9) | 0.18 |
D-dimer (ng/mL) | 3195 (1858–6208) | 2940 (1735–3550) | 5750 (2975–16,310) | 0.09 |
PaO2/FiO2 (mm Hg) | 56 (48–66) | 55 (48–66) | 56 (53–67) | 0.58 |
PaCO2 (mmHg) | 58 (47–67) | 56 (45–65) | 59 (48–69) | 0.55 |
Arterial pH | 7.31 (7.23–7.37) | 7.32 (7.25–7.38) | 7.27 (7.20–7.34) | 0.23 |
Shock, N (%) | 36 (90) | 25 (89) | 11 (92) | 1.0 |
Renal replacement therapy, N (%) | 20 (50) | 14 (50) | 6 (50) | 1.0 |
Time from first symptoms to ECMO (days) | 13 (10–17) | 12 (10–14) | 19 (16–28) | 0.0002 |
Length of ICU stay (days) | 31 (19–46) | 30 (17–46) | 37 (22–45) | 0.42 |
Length of hospital stay (days) | 39 (22–59) | 37 (21–62) | 39 (25–47) | 0.64 |
Parameters * | All Patients (N = 40) | ECMO before/during the 10-Day Dexamethasone Course (N = 28) | ECMO after the 10-Day Dexamethasone Course (N = 12) | p-Value |
---|---|---|---|---|
Survival, N (%) | 12 (30) | 12 (43) | 0 (0) | 0.007 |
Dexamethasone treatment, N (%) | 40 (100) | 28 (100) | 12 (100) | 1.0 |
Dexamethasone 6 mg/day regimen, N (%) | 21 (53) | 9 (32) | 12 (100) | <0.0001 |
Dexamethasone 20/1 mg/day regimen, N (%) | 19 (47) | 19 (78) | 0 (0) | <0.0001 |
Time from first symptoms to dexamethasone (days) | 9 (7–13) | 12 (8–15) | 7 (6–7) | 0.003 |
Tocilizumab treatment, N (%) | 8 (20) | 4 (14) | 4 (33) | 0.21 |
Number of prone sessions before ECMO | 3 (2–4) | 3 (2–4) | 3 (2–5) | 0.75 |
Inspired tidal volume (mL) | 352 (335–406) | 360 (343–400) | 350 (300–391) | 0.49 |
Plateau pressure (cm H2O) | 30 (28–32) | 29 (25–30) | 32 (29–34) | 0.013 |
Positive end-expiratory pressure (cm H2O) | 12 (10–14) | 12 (10–14) | 12 (10–14) | 0.65 |
Static compliance (mL/cm H2O) | 22 (16–29) | 25 (21–30) | 16 (13–19) | 0.02 |
Respiratory rate (cycle/min) | 30 (28–34) | 29 (27–32) | 33 (32–35) | 0.03 |
Total duration of mechanical ventilation (days) | 28 (16–35) | 26 (16–36) | 30 (19–36) | 0.82 |
Time from ICU admission to ECMO (days) | 7 (4–9) | 5 (2–7) | 12 (10–19) | <0.0001 |
Time from intubation to ECMO (days) | 4 (1–6) | 3 (1–5) | 7 (2–11) | 0.04 |
ECMO duration (days) | 14 (7–26) | 13 (6–21) | 26 (11–31) | 0.20 |
Parameters * | Survivors (N = 12) | Non-Survivors (N = 28) | p-Value |
---|---|---|---|
Age (years) | 51 (43–56) | 60 (57–64) | 0.0006 |
SOFA score on admission | 9 (4–11) | 7 (5–12) | 0.84 |
Time from first symptom to ECMO (days) | 12 (12–14) | 14 (10–17) | 0.31 |
Time from ICU admission to ECMO (days) | 4 (2–6) | 7 (5–11) | 0.017 |
Time from intubation to ECMO (days) | 3 (0–4) | 5 (2–7) | 0.03 |
Time from first symptom to dexamethasone (days) | 13 (7–15) | 9 (6–10) | 0.07 |
Serum creatinine (µmol/L) | 112 (54–196) | 116 (78–272) | 0.53 |
Renal replacement therapy, N (%) | 3 (25) | 17 (61) | 0.08 |
Blood lactate (mmol/L) | 1.4 (1.2–2.0) | 1.6 (1.2–2.8) | 0.56 |
PaO2/FiO2 at cannulation (mm Hg) | 55 (45–61) | 56 (48–68) | 0.43 |
Presence of shock, N (%) | 10 (83) | 26 (93) | 0.57 |
Arterial pH at cannulation | 7.37 (7.34–7.45) | 7.27 (7.20–7.33) | 0.002 |
Plateau pressure (cmH2O) | 26 (21–30) | 30 (29–33) | 0.015 |
Static compliance (ml/cmH2O) | 27 (20–30) | 21 (15–25) | 0.11 |
Positive end-expiratory pressure (cmH2O) | 12 (10–14) | 12 (10–14) | 0.95 |
Dexamethasone 6mg/day regimen, N (%) | 3 (25) | 18 (64) | 0.038 |
ECMO after at least 10-day dexamethasone, N (%) | 0 (0) | 12 (43) | 0.007 |
Parameters | Odds Ratio (CI) * | Area under the Curve of the Model (CI) | p-Value |
---|---|---|---|
Age | 0.855 (0.764–0.957) | 0.844 (0.694–0.939) | 0.0005 |
pH at cannulation | 1.97 × 106 (44.600–87.3 × 109) | 0.854 (0.696–0.949) | 0.0008 |
Time from ICU admission to ECMO | 0.796 (0.642–0.986) | 0.740 (0.577–0.865) | 0.007 |
Plateau pressure | 0.762 (0.601–0.951) | 0.786 (0.606–0.911) | 0.005 |
Time from intubation to ECMO | 0.759 (0.575–1.002) | 0.717 (0.553–0.848) | 0.019 |
Dexamethasone 6mg/day regimen | 0.1852 (0.041–0.845) | 0.696 (0.531–0.832) | 0.021 |
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Voicu, S.; Goury, A.; Lacoste-Palasset, T.; Malissin, I.; Fanet, L.; Souissi, S.; Busto, J.; Legros, V.; Sutterlin, L.; Naim, G.; et al. Dismal Survival in COVID-19 Patients Requiring ECMO as Rescue Therapy after Corticosteroid Failure. J. Pers. Med. 2021, 11, 1238. https://doi.org/10.3390/jpm11111238
Voicu S, Goury A, Lacoste-Palasset T, Malissin I, Fanet L, Souissi S, Busto J, Legros V, Sutterlin L, Naim G, et al. Dismal Survival in COVID-19 Patients Requiring ECMO as Rescue Therapy after Corticosteroid Failure. Journal of Personalized Medicine. 2021; 11(11):1238. https://doi.org/10.3390/jpm11111238
Chicago/Turabian StyleVoicu, Sebastian, Antoine Goury, Thomas Lacoste-Palasset, Isabelle Malissin, Lucie Fanet, Samar Souissi, Julia Busto, Vincent Legros, Laetitia Sutterlin, Giulia Naim, and et al. 2021. "Dismal Survival in COVID-19 Patients Requiring ECMO as Rescue Therapy after Corticosteroid Failure" Journal of Personalized Medicine 11, no. 11: 1238. https://doi.org/10.3390/jpm11111238