Mortalidad con ECMO en pacientes críticos infectados por SARS-CoV-2 durante la pandemia de COVID-19.Una revisión sistemática

  1. Néstor Báez Ferrer 1
  2. Alejandra Bompart Cairós 2
  3. Dénis López Rial 2
  4. Pedro Abreu González 3
  5. Daniel Hernández-Vaquero Panizo 4
  6. Alberto Domínguez Rodríguez 1
  1. 1 Servicio de Cardiología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, España
  2. 2 Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife, España
  3. 3 Departamento de Ciencias Médicas Básicas, Unidad de Fisiología, Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, España
  4. 4 Servicio de Cirugía Cardiaca, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
Aldizkaria:
REC: Interventional Cardiology

ISSN: 2604-7276 2604-7306

Argitalpen urtea: 2021

Alea: 3

Zenbakia: 3

Orrialdeak: 196-203

Mota: Artikulua

DOI: 10.24875/RECIC.M21000204 DIALNET GOOGLE SCHOLAR lock_openDialnet editor

Beste argitalpen batzuk: REC: Interventional Cardiology

Laburpena

Introducción y objetivos: El coronavirus del síndrome respiratorio agudo grave de tipo 2 (SARS-CoV-2) genera una enfermedad infecciosa que puede presentarse como síndrome de distrés respiratorio del adulto (SDRA). Sin un tratamiento farmacológico eficaz, el oxigenador extracorpóreo de membrana (ECMO) es fundamental cuando en los casos graves fracasa la ventilación mecánica invasiva. Presentamos una revisión sistemática de los trabajos publicados en el año 2020 para analizar la mortalidad de pacientes con SDRA por SARS-CoV-2 que precisaban ECMO. Métodos: Se realizó una revisión sistemática en Medline combinando palabras clave sobre SARS-CoV-2 y ECMO. Se incluyeron todos los estudios publicados durante el año 2020 que registraran casos positivos de SARS-CoV-2 tratados con ECMO, ya fueran estudios observacionales o series de casos. Sin embargo, debido a la heterogeneidad en la metodología de los trabajos, no se pudo llevar a cabo un análisis estadístico adecuado, lo cual limita los hallazgos. Resultados: La búsqueda identificó 41 publicaciones y se recogieron 2.007 casos de pacientes con infección grave por SARS-CoV-2 que precisaron soporte invasivo con ECMO. De estos, 985 (49%) mejoraron clínicamente y fueron descanulados o dados de alta del hospital, y 660 (32,8%) fallecieron a pesar del soporte invasivo. Solo 357 (17,7%) pacientes aún persistían con necesidad de asistencia ventilatoria con ECMO en el momento de la publicación de los estudios, sin que se describa la evolución clínica final. Conclusiones: El tratamiento con ECMO podría ser útil en pacientes con SDRA por SARS-CoV-2, según las directrices de las guías clínicas y en función de la disponibilidad de los recursos económicos durante la pandemia. La realización de un ensayo clínico aleatorizado que compare el uso de ECMO con el tratamiento convencional ventilatorio invasivo arrojaría mayor evidencia, con el fin de aportar más datos sobre el tratamiento de la infección grave por SARS-CoV-2.

Erreferentzia bibliografikoak

  • 1. Tang D, Comish P, Kang R. The hallmarks of COVID-19 disease. PLoS Pathog. 2020;16:1-24.
  • 2. Actualización n.º291. Enfermedad por el coronavirus (COVID-19). 15.01.2021. Disponible en https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/Actualizacion_291_COVID-19.pdf. Consultado 18 Ene 2021.
  • 3. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020;109:18-21.
  • 4. Yan-Rong G, Qing-Dong C. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak –an update on the status. Mil Med Res. 2020;7:11.
  • 5. George PM, Wells AU, Jenkins RG. Pulmonary fibrosis and COVID-19:the potential role for antifibrotic therapy. Lancet Respir Med. 2020;8:807-815.
  • 6. Thille AW, Esteban A, Fernández-Segoviano P, et al. Chronology of histological lesions in acute respiratory distress syndrome with diff use alveolar damage:A prospective cohort study of clinical autopsies. Lancet Respir Med. 2013;1:395-401.
  • 7. Bartlett RH, Ogino MT, Brodie D, et al. Initial ELSO Guidance Document:ECMO for COVID-19 Patients with Severe Cardiopulmonary Failure. ASAIO J. Published online 2020;472-474.
  • 8. Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators, Davies A, Jones D, Bailey M, et al. Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome. J Am Med Assoc. 2009;302:1888-1895.
  • 9. Noah MA, Peek GJ, Finney SJ, et al. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). J Am Med Assoc. 2011;306:1659-1668.
  • 10. Alshahrani MS, Sindi A, Alshamsi F, et al. Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. Ann Intensive Care. 2018;8:3.
  • 11. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions:Explanation and Elaboration. J Clin Epidemiol. 2009;62:e1-34.
  • 12. Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708-1720.
  • 13. Zhang G, Hu C, Luo L, et al. Clinical features and short-term outcomes of 221 patients with COVID-19 in Wuhan, China. J Clin Virol. 2020;127:104364.
  • 14. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China:a descriptive study. Lancet. 2020;395:507-513.
  • 15. Li X, Ma X. Acute respiratory failure in COVID-19:Is it “typical“ARDS?Crit Care. 2020;24:1-5.
  • 16. Kang Y, Chen T, Mui D, et al. Cardiovascular manifestations and treatment considerations in COVID-19. Heart. 2020;106:1132-1141.
  • 17. Li X, Guo Z, Li B, et al. Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019 in Shanghai, China. ASAIO J. 2020:475-481.
  • 18. Shi S, Qin M, Shen B, et al. Association of Cardiac Injury with Mortality in Hospitalized Patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5:802-810.
  • 19. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020;46:846-848.
  • 20. Rodríguez-Leor O, Cid-Álvarez B, Ojeda S, et al. Impact of the COVID-19 pandemic on interventional cardiology activity in Spain. REC Interv Cardiol. 2020;2:82-89.
  • 21. Khan R, Anandamurthy B, McCurry K, Krishnan S. Utility of extracorporeal membrane oxygenation in COVID-19. Cleve Clin J Med. 2020 May 5. doi:10.3949/ccjm.87a.ccc014.
  • 22. Li L, Li R, Wu Z, et al. Therapeutic strategies for critically ill patients with COVID-19. Ann Intensive Care. 2020;10:45.
  • 23. Henry BM. COVID-19, ECMO, and lymphopenia:a word of caution. Lancet Respir Med. 2020;8:e24.
  • 24. Barbaro R, MacLaren G, Boonstra P, Iwashyna, TH, Slutsky A, Fan E. Extracorporeal membrane oxygenation support in COVID-19:an international cohort study of the Extracorporeal Life Support Organization registry. Lancet. 2020;396:1071-1078.
  • 25. Henry BM, Lippi G. Poor survival with extracorporeal membrane oxygenation in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19):Pooled analysis of early reports. J Crit Care. 2020;58:27-28.
  • 26. Ñamendys-Silva SA. ECMO for ARDS due to COVID-19. Hear Lung. 2020;49:348-349.
  • 27. Oliveira TF de, Rocha CA de O, Santos AGG dos, et al. Extracorporeal Membrane Oxygenation in COVID-19 Treatment:a Systematic Literature Review. Brazilian J Cardiovasc Surg. 2021;8:84-123.
  • 28. Haiduc AA, Alom S, Melamed N, Harky A. Role of extracorporeal membrane oxygenation in COVID-19:A systematic review. J Card Surg. 2020;35:2679-2687.
  • 29. Melhuish TM, Vlok R, Thang C, Askew J, White L. Outcomes of extracorporeal membrane oxygenation support for patients with COVID- 19:A pooled analysis of 331 cases. Am J Emerg Med. 2020;39:245-246.
  • 30. Schmidt M, Hajage D, Lebreton G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19:a retrospective cohort study. Lancet Respir Med. 2020;8:1121-1131.
  • 31. Marullo A, Cavaretta E, Biondi-zoccai G, et al. Extracorporeal membrane oxygenation for critically ill patients with coronavirus-associated disease 2019 :an updated perspective of the European experience. Minerva Cardioangiol. 2020;68:368-372.
  • 32. Sultan I, Habertheuer A, Usman AA, et al. The role of extracorporeal life support for patients with COVID-19:Preliminary results from a statewide experience. J Card Surg. 2020;35:1410-1413.
  • 33. The Extracorporeal Life Support Organization (ELSO):ECMO in COVID-19. Disponible en: https://www.elso.org/Registry/FullCOVID19RegistryDashboard.aspx. Consultado 18 Ene 2021.
  • 34. Ahmadi ZH, Jahangirifard A, Farzanegan B, et al. Extracorporeal membrane oxygenation and COVID-19:The causes of failure. J Card Surg. 2020;35:2838-2843.
  • 35. Akhtar W, Olusanya O, Baladia MM, Young H, Shah S. SARS-CoV-2 and ECMO:early results and experience. Indian J Thorac Cardiovasc Surg. 2021;37:53-60.
  • 36. Alnababteh M, Hashmi MD, Vedantam K, et al. Extracorporeal membrane oxygenation for COVID-19 induced hypoxia:Single-center study. Perfusion (United Kingdom). 2020. http://dx.doi.org/10.1177/0267659120963885.
  • 37. Charlton M, Dashey S, Stubbs A, Lai FY, Tang JW. Comparing SARS-CoV-2 and influenza A(H1N1)pdm09-infected patients requiring ECMO. A single-centre, retrospective observational cohort experience. J Infect. 2021;8:84-123.
  • 38. Cousin N, Bourel C, Carpentier D, et al. SARS-CoV-2 versus influenza associated acute respiratory distress syndrome requiring veno-venous extracorporeal membrane oxygenation support. ASAIO J. 2021;67:125-131.
  • 39. Falcoz P-E, Puyraveau M, Perrier S, et al. Extracorporeal Membrane Oxygenation for Critically Ill Patients with COVID-19–related Acute Respiratory Distress Syndrome:Worth the Effort?Am J Respir Crit Care Med. 2020;202:460-463.
  • 40. Guo Z, Sun L, Li B. Anticoagulation Management in Severe Coronavirus Disease 2019 Patients on Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth. 2021;35:389-397.
  • 41. Hu H, Xu S, Wang J, Rao X. Respiratory Support in Severely or Critically Ill ICU Patients With COVID-19 in Wuhan, China. Curr Med Sci. 2020;40:636-641.
  • 42. Huang S, Xia H, Wu Z, et al. Clinical data of early COVID-19 cases receiving extracorporeal membrane oxygenation in Wuhan, China. J Clin Anesth. 2021;68:110044.
  • 43. Huette P, Beyls C, Guilbart M, et al. Extracorporeal membrane oxygenation for respiratory failure in COVID-19 patients:outcome and time-course of clinical and biological parameters. Can J Anesth. 2020;67:1486-1488.
  • 44. Jacobs JP, Stammers AH, Louis J, et al. Extracorporeal Membrane Oxygenation in the Treatment of Severe Pulmonary and Cardiac Compromise in Coronavirus Disease 2019:Experience with 32 Patients. ASAIO J. 2020;66:722-730.
  • 45. Kon ZN, Smith DE, Chang SH, et al. Extracorporeal Membrane Oxygenation Support in Severe COVID-19. Ann Thorac Surg. 2021;111:537-543.
  • 46. Breton C Le, Besset S, Amouretti M, Billiet PA, Dao M. Extracorporeal membrane oxygenation for refractory COVID-19 acute respiratory distress syndrome. J Crit Care. 2020;60:10-12.
  • 47. Li J, Xu G, Yu H, Peng X, Luo Y, Cao C. Clinical Characteristics and Outcomes of 74 Patients With Severe or Critical COVID-19. Am J Med Sci. 2020;360:229-235.
  • 48. Loforte A, Dal Checco E, Gliozzi G, et al. Veno-venous extracorporeal membrane oxygenation support in covid-19 respiratory distress syndrome:Initial experience. ASAIO J. 2020;66:734-738.
  • 49. Miike S, Sakamoto N, Washino T, et al. Critically ill patients with COVID-19 in Tokyo, Japan:A single-center case series. J Infect Chemother. 2021;27:291-295.
  • 50. Mustafa AK, Alexander PJ, Joshi DJ, et al. Extracorporeal Membrane Oxygenation for Patients with COVID-19 in Severe Respiratory Failure. JAMA Surg. 2020;155:990-992.
  • 51. Osho AA, Moonsamy P, Hibbert KA, et al. Veno-venous Extracorporeal Membrane Oxygenation for Respiratory Failure in COVID-19 Patients:Early Experience From a Major Academic Medical Center in North America. Ann Surg. 2020;272:e75-e78.
  • 52. Riera J, Argudo E, Martínez-Martínez M, et al. Extracorporeal Membrane Oxygenation Retrieval in Coronavirus Disease 2019:A Case-Series of 19 Patients Supported at a High-Volume Extracorporeal Membrane Oxygenation Center. Crit Care Explor. 2020;2:e0228.
  • 53. Rieg S, von Cube M, Kalbhenn J, et al. COVID-19 in-hospital mortality and mode of death in a dynamic and non-restricted tertiary care model in Germany. PLoS One. 2020;15:1-16.
  • 54. Santos-Martínez S, Martín Moreiras J, Vázquez-Álvarez M, Peñasco Y, Uribarri A, Amat-Santos I. Oxigenador extracorpóreo de membrana con implante percutáneo durante la pandemia de COVID-19. Registro multicéntrico español. REC Interv Cardiol. 2020;2:312-314.
  • 55. Schroeder I, Scharf C, Zoller M, et al. Characteristics and outcome of 70 ventilated COVID-19 patients:Summary after the first wave at a university center. Anaesthesist. 2020. http://dx.doi.org/10.1007/s00101-020-00906-3.
  • 56. Shen C, Wang Z, Zhao F, et al. Treatment of 5 Critically Ill Patients with COVID-19 with Convalescent Plasma. J Am Med Assoc. 2020;323:1582-1589.
  • 57. Sromicki J, Schmiady M, Maisano F, Mestres CA. ECMO therapy in COVID-19:The Zurich experience. J Card Surg. 2021;36:1707-12.
  • 58. Wu C, Chen X, Cai Y, et al. Risk Factors Associated with Acute Respiratory Distress Syndrome and Death in Patients with Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180:934-943.
  • 59. Xu Y, Xu Z, Liu X, et al. Clinical Findings of COVID-19 Patients Admitted to Intensive Care Units in Guangdong Province, China:A Multicenter, Retrospective, Observational Study. Front Med. 2020;7:1-9.
  • 60. Xuan W, Chen C, Jiang X, et al. Clinical characteristics and outcomes of five critical COVID-19 patients treated with extracorporeal membrane oxygenation in Leishenshan Hospital in Wuhan. J Clin Anesth. 2020;67:110033.
  • 61. Yang X, Cai S, Luo Y, et al. Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019-Induced Acute Respiratory Distress Syndrome:A Multicenter Descriptive Study. Crit Care Med. 2020;3:1289-1295.
  • 62. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China:a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8:475-481.
  • 63. Yang Y, Rali AS, Inchaustegui C, et al. Extracorporeal Membrane Oxygenation in Coronavirus Disease 2019-associated Acute Respiratory Distress Syndrome:An initial US Experience at a High-volume Centre. Card Fail Rev. 2020;6:7-9.
  • 64. Yankah CA, Trimlett R, Sandoval E, et al. COVID-19 Pulmonary Failure and Extracorporeal Membrane Oxygenation:First Experience from Three European Extracorporeal Membrane Oxygenation Centers. Thorac Cardiovasc Surg. 2021;69:259-62.
  • 65. Yao K, Hasegawa S, Tagashira Y, et al. Experience of 101 patients with coronavirus infectious disease 2019 (COVID-19) at a tertiary care center in Japan. J Infect Chemother. 2021;27:413-417.
  • 66. Zayat R, Kalverkamp S, Grottke O, et al. Role of extracorporeal membrane oxygenation in critically Ill COVID-19 patients and predictors of mortality. Artif Organs. 2020. http://dx.doi.org/10.1111/aor.13873.
  • 67. Zeng Y, Cai Z, Xianyu Y, Yang BX, Song T, Yan Q. Prognosis when using extracorporeal membrane oxygenation (ECMO) for critically ill COVID-19 patients in China:A retrospective case series. Crit Care. 2020;24:8-10.
  • 68. Zhang J, Merrick B, Correa GL, et al. Veno-venous extracorporeal membrane oxygenation in coronavirus disease 2019:a case series. ERJ Open Res. 2020;6:00463-02020.
  • 69. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China:a retrospective cohort study. Lancet. 2020;395:1054-1062.