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Article Dans Une Revue European Journal of Anaesthesiology Année : 2022

A retrospective comparison of COVID-19 and seasonal influenza mortality and outcomes in the ICUs of a French university hospital

Donatien de Marignan
  • Fonction : Auteur
Charles-Hervé Vacheron
Florence Ader
  • Fonction : Auteur
Maxime Lecocq
  • Fonction : Auteur
Emilie Frobert
  • Fonction : Auteur
  • PersonId : 903225
Jean Sebastien Casalegno
  • Fonction : Auteur
Sandrine Couray-Targe
  • Fonction : Auteur
Laurent Argaud
  • Fonction : Auteur
Thomas Rimmele
  • Fonction : Auteur
Frédéric Aubrun
  • Fonction : Auteur
Frédéric Dailler
  • Fonction : Auteur
Jean Luc Fellahi
  • Fonction : Auteur
Julien Bohe
  • Fonction : Auteur
Vincent Piriou
  • Fonction : Auteur
Bernard Allaouchiche
Arnaud Friggeri
  • Fonction : Auteur
Florent Wallet
  • Fonction : Auteur

Résumé

Background Despite expanding use, knowledge on extracorporeal membrane oxygenation support during the COVID-19 pandemic remains limited. The objective was to report characteristics, management, and outcomes of patients receiving extracorporeal membrane oxygenation with a diagnosis of COVID-19 in France and to identify pre-extracorporeal membrane oxygenation factors associated with in-hospital mortality. A hypothesis of similar mortality rates and risk factors for COVID-19 and non–COVID-19 patients on venovenous extracorporeal membrane oxygenation was made. Methods The Extracorporeal Membrane Oxygenation for Respiratory Failure and/or Heart failure related to Severe Acute Respiratory Syndrome-Coronavirus 2 (ECMOSARS) registry included COVID-19 patients supported by extracorporeal membrane oxygenation in France. This study analyzed patients included in this registry up to October 25, 2020, and supported by venovenous extracorporeal membrane oxygenation for respiratory failure with a minimum follow-up of 28 days after cannulation. The primary outcome was in-hospital mortality. Risk factors for in-hospital mortality were analyzed. Results Among 494 extracorporeal membrane oxygenation patients included in the registry, 429 were initially supported by venovenous extracorporeal membrane oxygenation and followed for at least 28 days. The median (interquartile range) age was 54 yr (46 to 60 yr), and 338 of 429 (79%) were men. Management before extracorporeal membrane oxygenation cannulation included prone positioning for 411 of 429 (96%), neuromuscular blockage for 419 of 427 (98%), and NO for 161 of 401 (40%). A total of 192 of 429 (45%) patients were cannulated by a mobile extracorporeal membrane oxygenation unit. In-hospital mortality was 219 of 429 (51%), with a median follow-up of 49 days (33 to 70 days). Among pre-extracorporeal membrane oxygenation modifiable exposure variables, neuromuscular blockage use (hazard ratio, 0.286; 95% CI, 0.101 to 0.81) and duration of ventilation (more than 7 days compared to less than 2 days; hazard ratio, 1.74; 95% CI, 1.07 to 2.83) were independently associated with in-hospital mortality. Both age (per 10-yr increase; hazard ratio, 1.27; 95% CI, 1.07 to 1.50) and total bilirubin at cannulation (6.0 mg/dl or more compared to less than 1.2 mg/dl; hazard ratio, 2.65; 95% CI, 1.09 to 6.5) were confounders significantly associated with in-hospital mortality. Conclusions In-hospital mortality was higher than recently reported, but nearly half of the patients survived. A high proportion of patients were cannulated by a mobile extracorporeal membrane oxygenation unit. Several factors associated with mortality were identified. Venovenous extracorporeal membrane oxygenation support should be considered early within the first week of mechanical ventilation initiation. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
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Dates et versions

hal-03706874 , version 1 (28-06-2022)

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Citer

Donatien de Marignan, Charles-Hervé Vacheron, Florence Ader, Maxime Lecocq, Jean-Christophe Richard, et al.. A retrospective comparison of COVID-19 and seasonal influenza mortality and outcomes in the ICUs of a French university hospital. European Journal of Anaesthesiology, 2022, 39 (5), pp.427-435. ⟨10.1097/EJA.0000000000001672⟩. ⟨hal-03706874⟩
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