Article Dans Une Revue The Lancet Respiratory Medicine Année : 2023

Comparative outcomes of extracorporeal membrane oxygenation for COVID-19 delivered in experienced European centres during successive SARS-CoV-2 variant outbreaks (ECMO-SURGES): an international, multicentre, retrospective cohort study

1 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
2 Institut de cardiologie [CHU Pitié-Salpêtrière]
3 CIC Paris-Est - Centre d'investigation clinique Paris Est [CHU Pitié Salpêtrière]
4 CHU Pitié-Salpêtrière [AP-HP]
5 PEPITES - Pharmacoépidémiologie et évaluation des soins [iPLesp]
6 SU - Sorbonne Université
7 Universität Witten/Herdecke
8 RWTH Aachen - RWTH Aachen University = Rheinisch-Westfälische Technische Hochschule Aachen
9 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
10 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
11 CHU Marseille
12 U955 Inserm - UPEC - IMRB - "Biomechanics and Respiratory Apparatus" [Créteil]
13 CHU Henri Mondor [Créteil]
14 CARMAS - Groupe de recherche clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis)
15 Vall d'Hebron University Hospital [Barcelona]
16 RPH - Royal Papworth Hospital [Cambridge, UK]
17 Hospital General Universitario "Gregorio Marañón" [Madrid]
18 IRCCS - Istituti di Ricovero e Cura a Carattere Scientifico
19 ISMETT - Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione
20 Universidad Loyola Andalucía = Loyola University Andalucía
21 Hospital de São João [Porto]
22 Hospital Universitario Ramón y Cajal [Madrid]
23 RHUH - Rio Hortega University Hospital (Hospital Universitario Río Hortega) [Valladolid, Spain]
24 GTPUH - Germans Trias i Pujol University Hospital [Badalona, Barcelona, Spain]
25 Hospital Universitari i Politècnic La Fe = University and Polytechnic Hospital La Fe
26 Hospital Clínico Universitario Virgen de la Arrixaca = University Hospital Virgen de la Arrixaca [Murcia]
27 Centro Hospitalar de Lisboa Central E.P.E
28 MedUni Vienna - Medical University of Vienna = Medizinische Universität Wien
29 UZ Leuven - Universitair Ziekenhuis Leuven = University Hospital of Leuven = Hopital universitaire de Louvain
30 Service d'anesthésie et soins intensifs [CHRU Besançon]
31 PCVP / CARDIO - Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920)
32 KU Leuven - Catholic University of Leuven = Katholieke Universiteit Leuven
33 Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
34 CEReSS - Centre d'études et de recherche sur les services de santé et la qualité de vie
35 VHRI - Vall d'Hebron Research Institute - Institut de Recerca Vall d’Hebron
Matthieu Amalric
  • Fonction : Auteur

Résumé

Background. To inform future research and practice, we aimed to investigate the outcomes of patients who received extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) due to different variants of SARS-CoV-2. Methods. This retrospective study included consecutive adult patients with laboratory-confirmed SARS-CoV-2 infection who received ECMO for ARDS in 21 experienced ECMO centres in eight European countries (Austria, Belgium, England, France, Germany, Italy, Portugal, and Spain) between Jan 1, 2020, and Sept 30, 2021. We collected data on patient characteristics, clinical status, and management before and after the initiation of ECMO. Participants were grouped according to SARS-CoV-2 variant (wild type, alpha, delta, or other) and period of the pandemic (first [Jan 1–June 30] and second [July 1–Dec 31] semesters of 2020, and first [Jan 1–June 30] and second [July 1–Sept 30] semesters of 2021). Descriptive statistics and Kaplan-Meier survival curves were used to analyse evolving characteristics, management, and patient outcomes over the first 2 years of the pandemic, and independent risk factors of mortality were determined using multivariable Cox regression models. The primary outcome was mortality 90 days after the initiation of ECMO, with follow-up to Dec 30, 2021. Findings. ECMO was initiated in 1345 patients. Patient characteristics and management were similar for the groups of patients infected with different variants, except that those with the delta variant had a younger median age and less hypertension and diabetes. 90-day mortality was 42% (569 of 1345 patients died) overall, and 43% (297/686) in patients infected with wild-type SARS-CoV-2, 39% (152/391) in those with the alpha variant, 40% (78/195) in those with the delta variant, and 58% (42/73) in patients infected with other variants (mainly beta and gamma). Mortality was 10% higher (50%) in the second semester of 2020, when the wild-type variant was still prevailing, than in other semesters (40%). Independent predictors of mortality were age, immunocompromised status, a longer time from intensive care unit admission to intubation, need for renal replacement therapy, and higher Sequential Organ Failure Assessment haemodynamic component score, partial pressure of arterial carbon dioxide, and lactate concentration before ECMO. After adjusting for these variables, mortality was significantly higher with the delta variant than with the other variants, the wild-type strain being the reference. Interpretation. Although crude mortality did not differ between variants, adjusted risk of death was highest for patients treated with ECMO infected with the delta variant of SARS-CoV-2. The higher virulence and poorer outcomes associated with the delta strain might relate to higher viral load and increased inflammatory response syndrome in infected patients, reinforcing the need for a higher rate of vaccination in the population and updated selection criteria for ECMO, should a new and highly virulent strain of SARS-CoV-2 emerge in the future. Mortality was noticeably lower than in other large, multicentre series of patients who received ECMO for COVID-19, highlighting the need to concentrate resources at experienced centres.

Fichier principal
Vignette du fichier
ECMO_Surges_V_Sub_LRM_R2 Clean.pdf (1.11 Mo) Télécharger le fichier
Origine Fichiers produits par l'(les) auteur(s)
Licence

Dates et versions

hal-03935806 , version 1 (12-01-2023)

Licence

Identifiants

Citer

Matthieu Schmidt, David Hajage, Micha Landoll, Benjamin Pequignot, Elise Langouet, et al.. Comparative outcomes of extracorporeal membrane oxygenation for COVID-19 delivered in experienced European centres during successive SARS-CoV-2 variant outbreaks (ECMO-SURGES): an international, multicentre, retrospective cohort study. The Lancet Respiratory Medicine, 2023, 11 (2), pp.163-175. ⟨10.1016/S2213-2600(22)00438-6⟩. ⟨hal-03935806⟩
436 Consultations
248 Téléchargements

Altmetric

Partager

  • More