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Outcomes of severe systemic rheumatic disease patients requiring extracorporeal membrane oxygenation

Authors
  • Bay, Pierre1
  • Lebreton, Guillaume2
  • Mathian, Alexis3, 4
  • Demondion, Pierre2
  • Desnos, Cyrielle1
  • Chommeloux, Juliette1
  • Hékimian, Guillaume1
  • Bréchot, Nicolas1
  • Nieszkowska, Ania1
  • Schmidt, Matthieu1, 5
  • Cohen-Aubart, Fleur3, 4
  • Leprince, Pascal2
  • Luyt, Charles-Edouard1, 5
  • Amoura, Zahir3, 4
  • Combes, Alain1, 5
  • Pineton de Chambrun, Marc1, 3, 4, 5
  • 1 Hôpital La Pitié–Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France , Paris (France)
  • 2 Hôpital La Pitié–Salpêtrière, Institut de Cardiologie, Sorbonne Université, APHP, Paris, France , Paris (France)
  • 3 Sorbonne Université, Hôpital La Pitié–Salpêtrière, 47–83, Boulevard de L’Hôpital, Paris Cedex 13, 75651, France , Paris Cedex 13 (France)
  • 4 Centre de Référence National Lupus Systémique, Syndrome Des Anticorps Anti-Phospholipides Et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France , Paris (France)
  • 5 Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France , Paris (France)
Type
Published Article
Journal
Annals of Intensive Care
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Feb 09, 2021
Volume
11
Issue
1
Identifiers
DOI: 10.1186/s13613-021-00819-3
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundSystemic rheumatic diseases (SRDs) are a group of inflammatory disorders that can require intensive care unit (ICU) admission because of multiorgan involvement with end-organ failure(s). Critically ill SRD patients requiring extracorporeal membrane oxygenation (ECMO) were studied to gain insight into their characteristics and outcomes.MethodsThis French monocenter, retrospective study included all SRD patients requiring venovenous (VV)- or venoarterial (VA)-ECMO admitted to a 26-bed ECMO-dedicated ICU from January 2006 to February 2020. The primary endpoint was in-hospital mortality.ResultsNinety patients (male/female ratio: 0.5; mean age at admission: 41.6 ± 15.2 years) admitted to the ICU received VA/VV-ECMO, respectively, for an SRD-related flare (n = 69, n = 38/31) or infection (n = 21, n = 10/11). SRD was diagnosed in-ICU for 31 (34.4%) patients. In-ICU and in-hospital mortality rates were 48.9 and 51.1%, respectively. Nine patients were bridged to cardiac (n = 5) or lung transplantation (n = 4), or left ventricular assist device (n = 2). The Cox multivariable model retained the following independent predictors of in-hospital mortality: in-ICU SRD diagnosis, day-0 Simplified Acute Physiology Score (SAPS) II score ≥ 70 and arterial lactate ≥ 7.5 mmol/L for VA-ECMO–treated patients; diagnosis other than vasculitis, day-0 SAPS II score ≥ 70, ventilator-associated pneumonia and arterial lactate ≥ 7.5 mmol/L for VV-ECMO–treated patients.ConclusionsECMO support is a relevant rescue technique for critically ill SRD patients, with 49% survival at hospital discharge. Vasculitis was independently associated with favorable outcomes of VV-ECMO–treated patients. Further studies are needed to specify the role of ECMO for SRD patients.

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