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Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus

Article scientifique 2018 Anglais

Résumé

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

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Alshahrani, M., Sindi, A., Alshamsi, F., Al‐Omari, A., Tahan, M., Alahmadi, B., Zein, A., Khatani, N., Al-Hameed, F., Alamri, S., Abdelzaher, M., Alghamdi, A., Alfousan, F., Tash, A., Tashkandi, W., Al‐Raddadi, R., Lewis, K., Badawee, M., Arabi, Y., Fan, E., Alhazzani, W. (2018). Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. https://doi.org/10.1186/s13613-017-0350-x

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Auteur(s)

Mohammed Alshahrani Anees Sindi Fayez Alshamsi Awad Al‐Omari Mohamed El Tahan Bayan Alahmadi Ahmed Ragab Zein Naif Khatani Fahad Al-Hameed Sultan Alamri Mohammed Abdelzaher Amenah Alghamdi Faisal Alfousan Adel Tash Wail Tashkandi Rajaa Al‐Raddadi Kimberley Lewis Mohammed A. Badawee Yaseen M. Arabi Eddy Fan Waleed Alhazzani

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