Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus

Annals of Intensive Care - Tập 8 - Trang 1-10 - 2018
Mohammed S. Alshahrani1, Anees Sindi2, Fayez Alshamsi3, Awad Al-Omari4, Mohamed El Tahan5, Bayan Alahmadi6, Ahmed Zein7, Naif Khatani6, Fahad Al-Hameed8,9, Sultan Alamri10, Mohammed Abdelzaher11, Amenah Alghamdi12, Faisal Alfousan12, Adel Tash13, Wail Tashkandi14, Rajaa Alraddadi15, Kim Lewis16, Mohammed Badawee17, Yaseen M. Arabi18, Eddy Fan19, Waleed Alhazzani20
1Department of Emergency and Critical Care, King Fahad Hospital of the University-Dammam University, Al Khobar, Saudi Arabia
2Department of Medicine/Intensive Care, King Abdulaziz University, Jeddah, Saudi Arabia
3Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
4Medical Director of Critical Care, Dr. Suliman Al-Habib Group, AlFaisal University, Riyadh, Saudi Arabia
5Department of Anesthesiology, Dammam University, Dammam, Saudi Arabia
6King Abdulaziz University, Jeddah, Saudi Arabia
7Department of ICU, King Fahad Hospital, Jeddah, Saudi Arabia
8King Abdulaziz Medical City, NGHA, Jeddah, Saudi Arabia
9Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
10Department of ICU National Hospital, Internal Medicine and Critical Care, Riyadh, Saudi Arabia
11Critical Care Medicine Department, Cairo University Hospitals, Cairo, Egypt
12Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
13Department of Cardiac Surgery, King Abdullah Medical City, Makkah, Saudi Arabia
14Department of Surgery/Intensive Care, King Abdulaziz University, Jeddah, Saudi Arabia
15Community Medicine Department, Ministry of Health, Jeddah, Saudi Arabia
16Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada
17Department of Critical Care, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
18King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
19Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
20Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada

Tóm tắt

Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS‐CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in severely hypoxemic patients who failed conventional strategies. We collected data retrospectively on MERS-CoV patients with refractory respiratory failure from April 2014 to December 2015 in 5 intensive care units (ICUs) in Saudi Arabia. Patients were classified into two groups: ECMO versus conventional therapy. Our primary outcome was in-hospital mortality; secondary outcomes included ICU and hospital length of stay. Thirty-five patients were included; 17 received ECMO and 18 received conventional therapy. Both groups had similar baseline characteristics. The ECMO group had lower in-hospital mortality (65 vs. 100%, P = 0.02), longer ICU stay (median 25 vs. 8 days, respectively, P < 0.01), and similar hospital stay (median 41 vs. 31 days, P = 0.421). In addition, patients in the ECMO group had better PaO2/FiO2 at days 7 and 14 of admission to the ICU (124 vs. 63, and 138 vs. 36, P < 0.05), and less use of norepinephrine at days 1 and 14 (29 vs. 80%; and 36 vs. 93%, P < 0.05). ECMO use, as a rescue therapy, was associated with lower mortality in MERS patients with refractory hypoxemia. The results of this, largest to date, support the use of ECMO as a rescue therapy in patients with severe MERS-CoV.

Tài liệu tham khảo

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Annals of Intensive Care

Tập 8

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