Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study
- Type de publi. : Article dans une revue
- Date de publi. : 01/08/2021
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Auteurs :
Guillaume LebretonMatthieu SchmidtMaharajah PonnaiahThierry FolliguetMarylou ParaJulien GuihaireEmmanuel LansacÉdouard SageBernard CholleyBruno MégarbanePierrick CronierJonathan ZarkaDaniel da SilvaSebastien BessetTristan Morichau-BeauchantIgor LacombatNicolas MongardonChristian RichardJacques DuranteauCharles CerfGabriel SaiydounRomain SonnevilleJean-Daniel ChichePatrick NatafDan LongroisAlain CombesPascal LeprinceCharles JuvinThibault SchoellCosimo d'AlessandroSofica MarinNathalie NardonePierre DemondionHoracio MeyerKarl BounaderAlexander Moiroux-SahraouiAli AkamkamGuillaume FadelErwan RandrianalisoaSébastien CusquelPatrice Le GloahecElisabeth HirschauerFabrice MusquetPierre-Marie JegoHélène GuedesThéophile RoyLina MercereauEmmanuel CorvolAnne LaboureFlore VilanoveMarco PeperoniDariène MachadoAly SelyMarion FortanierSéverine GantoisEmilie TranElisabeth BosqAurélie FontanierAlice MorinJocelyne CousinStéphanie BovagnetCharles-Edouard LuytGuillaume HékimianNicolas BréchotMarc Pineton de ChambrunCyrielle DesnosJuliette ChomelouxJeremy ArzoineEmmanuelle GuerinAntoine MonselGuillaume VoiriotDavid LevyElodie BaronAlexandra BeurtonJuliette ChommelouxMeng ParisSafaa NemlaghiPierre BayAlexandre DemouleBertrand GuidetJean Michel ConstantinMuriel FartoukhMartin DresPatrick NatafGuillaume FranchineauLucie Le FevreRichard RaffoulSoleiman AlkhoderWalid GhodbaneAngelo PisaniWael BrahamAli Bessem GaraPierre MordantYves-Hervé CastierEtienne de MontmollinLila BouadmaJean-François TimsitOlivier LangeronQuentin de RouxClaire AlessandriMargot Arminot-FrémauxSimon ClariotThomas DessalleAgathe KudelaAndré LyArnaud MeffertElena SkripkinaAntonio FioreCostin RaduEleonora Dupuy-MontbrunChristian LatremouilleOlaf MercierPhilippe DeleuzeFrançois StephanJacques DuranteauChristian RichardMarie WernerJean-Louis TeboulXavier MonnetHassan DebbaghAlain ChapelierJulien de WolfMatthieu GlorionCiprian PricopiFrancesco CassianoSébastien JacqueminGuillaume TachonFrançois ParquinBenjamin ZuberAlain CarriouJean-Paul MiraJulien CharpentierFrederic PeneLee NguyenSébastian VoicuNicolas DeyeIsabelle MalissinLaetitia SutterlinGiulia NaimAdrien Pépin-LehalleurAymen MradJean-Michel EkhérianPhilippe NguyenGeorgios SidérisDominique VodovarCaroline GrantMattéo ArcelliAlban CopieZaccaria ErrabihAntoine GondeAdèle MagalhaesEdouard MeurisseKiyoko NitenbergArthur PeraultLucile PerrinMaxime RenauxSophie MarquéLuis Ensenyat-MartinEric DelpierreMatthieu DupreyDaniel da SilvaBruno VerdièreJulien AmourMarina ClémentYves OllivierTristan Morichau-BeauchantFabrice DaviaudCamille Le BretonSantiago Freita-RamosMarc AmourettiPierre Antoine BillietMyriam DaoLouis Marie DumontLaura FedericiBaptiste GaborieauPierre Postel-VinayConstance VuillardNoémie ZucmanDidier DreyfussJean Damien RicardDamien Roux
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Organismes :
CHU Pitié-Salpêtrière [AP-HP]
Institut de cardiologie [CHU Pitié-Salpêtrière]
Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
Hôpital Henri Mondor
Molecular virology and immunology – Physiopathology and therapeutic of chronic viral hepatitis (Team 18)
AP-HP - Hôpital Bichat - Claude Bernard [Paris]
Hôpital Marie-Lannelongue
Institut Mutualiste de Montsouris
Hôpital Foch [Suresnes]
Hôpital Foch [Suresnes]
Université Paris Cité
Hôpital Européen Georges Pompidou [APHP]
Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière]
Optimisation thérapeutique en Neuropsychopharmacologie
Centre Hospitalier Sud Francilien
Grand Hôpital de l'Est Francilien
Hôpital Delafontaine
Laboratoire de Tribologie et Dynamique des Systèmes
Centre cardiologique du Nord
Hôpital Privé Jacques Cartier [Massy]
CHU Henri Mondor [Créteil]
Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
Hôpitaux Universitaires Paris Sud [AP-HP]
Université Paris-Sud - Paris 11
Hôpital Foch [Suresnes]
Service de Réanimation Médicale, Hôpital Foch
Hôpital Henri Mondor
- Publié dans The Lancet Respiratory Medicine le 23/10/2020
Résumé : Background: In the Île-de-France region (henceforth termed Greater Paris), extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) was considered early in the COVID-19 pandemic. We report ECMO network organisation and outcomes during the first wave of the pandemic.Methods: In this multicentre cohort study, we present an analysis of all adult patients with laboratory-confirmed SARS-CoV-2 infection and severe ARDS requiring ECMO who were admitted to 17 Greater Paris intensive care units between March 8 and June 3, 2020. Central regulation for ECMO indications and pooling of resources were organised for the Greater Paris intensive care units, with six mobile ECMO teams available for the region. Details of complications (including ECMO-related complications, renal replacement therapy, and pulmonary embolism), clinical outcomes, survival status at 90 days after ECMO initiation, and causes of death are reported. Multivariable analysis was used to identify pre-ECMO variables independently associated with 90-day survival after ECMO.Findings: The 302 patients included who underwent ECMO had a median age of 52 years (IQR 45-58) and Simplified Acute Physiology Score-II of 40 (31-56), and 235 (78%) of whom were men. 165 (55%) were transferred after cannulation by a mobile ECMO team. Before ECMO, 285 (94%) patients were prone positioned, median driving pressure was 18 cm H2O (14-21), and median ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen was 61 mm Hg (IQR 54-70). During ECMO, 115 (43%) of 270 patients had a major bleeding event, 27 of whom had intracranial haemorrhage; 130 (43%) of 301 patients received renal replacement therapy; and 53 (18%) of 294 had a pulmonary embolism. 138 (46%) patients were alive 90 days after ECMO. The most common causes of death were multiorgan failure (53 [18%] patients) and septic shock (47 [16%] patients). Shorter time between intubation and ECMO (odds ratio 0·91 [95% CI 0·84-0·99] per day decrease), younger age (2·89 [1·41-5·93] for ≤48 years and 2·01 [1·01-3·99] for 49-56 years vs ≥57 years), lower pre-ECMO renal component of the Sequential Organ Failure Assessment score (0·67, 0·55-0·83 per point increase), and treatment in centres managing at least 30 venovenous ECMO cases annually (2·98 [1·46-6·04]) were independently associated with improved 90-day survival. There was no significant difference in survival between patients who had mobile and on-site ECMO initiation.Interpretation: Beyond associations with similar factors to those reported on ECMO for non-COVID-19 ARDS, 90-day survival among ECMO-assisted patients with COVID-19 was strongly associated with a centre's experience in venovenous ECMO during the previous year. Early ECMO management in centres with a high venovenous ECMO case volume should be advocated, by applying centralisation and regulation of ECMO indications, which should also help to prevent a shortage of resources.
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