Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study
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. In th...
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| Veröffentlicht in: | The lancet respiratory medicine 2021-08, Vol.9 (8), p.851-862 |
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| creator | Schmidt, Matthieu Guihaire, Julien Cholley, Bernard Mégarbane, Bruno Cronier, Pierrick Da Silva, Daniel Lacombat, Igor Duranteau, Jacques Cerf, Charles Sonneville, Romain Longrois, Dan Leprince, Pascal SCHOELL, Thibault MARIN, Sofica BOUNADER, Karl FADEL, Guillaume RANDRIANALISOA, Erwan CUSQUEL, Sébastien Jego, Pierre-Marie Guedes, Hélène Mercereau, Lina Vilanove, Flore Peperoni, Marco Sely, Aly Gantois, Séverine Bosq, Elisabeth Fontanier, Aurélie Morin, Alice Cousin, Jocelyne Bovagnet, Stéphanie Luyt, Charles Edouard Hekimian, Guillaume Brechot, Nicolas Pineton de Chambrun, Marc Desnos, Cyrielle Chomeloux, Juliette Arzoine, Jeremy Voiriot, Guillaume Baron, Elodie Beurton, Alexandra Chommeloux, Juliette Bay, Pierre Demoule, Alexandre Guidet, Bertrand Constantin, Jean Michel Fartoukh, Muriel Nataf, Patrick Franchineau, Guillaume Le Fevre, Lucie Raffoul, Richard Ghodbane, Walid MORDANT, Pierre CASTIER, Yves-Hervé de MONTMOLLIN, Etienne TIMSIT, Jean-François Langeron, Olivier de Roux, Quentin Alessandri, Claire Arminot-Frémaux, Margot Clariot, Simon Kudela, Agathe Ly, André Meffert, Arnaud Skripkina, Elena Fiore, Antonio Latremouille, Christian Mercier, Olaf Deleuze, Philippe STEPHAN, François Duranteau, Jacques Richard, Christian Monnet, Xavier Debbagh, Hassan De Wolf, Julien Glorion, Matthieu Cassiano, Francesco Tachon, Guillaume Parquin, François Zuber, Benjamin Voicu, Sébastian Deye, Nicolas Malissin, Isabelle Pépin-Lehalleur, Adrien Nguyen, Philippe Sidéris, Georgios Vodovar, Dominique Grant, Caroline Gonde, Antoine Magalhaes, Adèle Nitenberg, Kiyoko Marqué, Sophie Ensenyat-Martin, Luis Delpierre, Eric da Silva, Daniel Freita-Ramos, Santiago Dao, Myriam Federici, Laura Gaborieau, Baptiste Postel-Vinay, Pierre Dreyfuss, Didier |
| description | 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.
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.
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.
Beyond associatio |
| doi_str_mv | 10.1016/S2213-2600(21)00096-5 |
| format | Article |
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Guihaire, Julien ; Cholley, Bernard ; Mégarbane, Bruno ; Cronier, Pierrick ; Da Silva, Daniel ; Lacombat, Igor ; Duranteau, Jacques ; Cerf, Charles ; Sonneville, Romain ; Longrois, Dan ; Leprince, Pascal ; SCHOELL, Thibault ; MARIN, Sofica ; BOUNADER, Karl ; FADEL, Guillaume ; RANDRIANALISOA, Erwan ; CUSQUEL, Sébastien ; Jego, Pierre-Marie ; Guedes, Hélène ; Mercereau, Lina ; Vilanove, Flore ; Peperoni, Marco ; Sely, Aly ; Gantois, Séverine ; Bosq, Elisabeth ; Fontanier, Aurélie ; Morin, Alice ; Cousin, Jocelyne ; Bovagnet, Stéphanie ; Luyt, Charles Edouard ; Hekimian, Guillaume ; Brechot, Nicolas ; Pineton de Chambrun, Marc ; Desnos, Cyrielle ; Chomeloux, Juliette ; Arzoine, Jeremy ; Voiriot, Guillaume ; Baron, Elodie ; Beurton, Alexandra ; Chommeloux, Juliette ; Bay, Pierre ; Demoule, Alexandre ; Guidet, Bertrand ; Constantin, Jean Michel ; Fartoukh, Muriel ; Nataf, Patrick ; Franchineau, Guillaume ; Le Fevre, Lucie ; Raffoul, Richard ; Ghodbane, Walid ; MORDANT, Pierre ; CASTIER, Yves-Hervé ; de MONTMOLLIN, Etienne ; TIMSIT, Jean-François ; Langeron, Olivier ; de Roux, Quentin ; Alessandri, Claire ; Arminot-Frémaux, Margot ; Clariot, Simon ; Kudela, Agathe ; Ly, André ; Meffert, Arnaud ; Skripkina, Elena ; Fiore, Antonio ; Latremouille, Christian ; Mercier, Olaf ; Deleuze, Philippe ; STEPHAN, François ; Duranteau, Jacques ; Richard, Christian ; Monnet, Xavier ; Debbagh, Hassan ; De Wolf, Julien ; Glorion, Matthieu ; Cassiano, Francesco ; Tachon, Guillaume ; Parquin, François ; Zuber, Benjamin ; Voicu, Sébastian ; Deye, Nicolas ; Malissin, Isabelle ; Pépin-Lehalleur, Adrien ; Nguyen, Philippe ; Sidéris, Georgios ; Vodovar, Dominique ; Grant, Caroline ; Gonde, Antoine ; Magalhaes, Adèle ; Nitenberg, Kiyoko ; Marqué, Sophie ; Ensenyat-Martin, Luis ; Delpierre, Eric ; da Silva, Daniel ; Freita-Ramos, Santiago ; Dao, Myriam ; Federici, Laura ; Gaborieau, Baptiste ; Postel-Vinay, Pierre ; Dreyfuss, Didier</creator><creatorcontrib>Schmidt, Matthieu ; Guihaire, Julien ; Cholley, Bernard ; Mégarbane, Bruno ; Cronier, Pierrick ; Da Silva, Daniel ; Lacombat, Igor ; Duranteau, Jacques ; Cerf, Charles ; Sonneville, Romain ; Longrois, Dan ; Leprince, Pascal ; SCHOELL, Thibault ; MARIN, Sofica ; BOUNADER, Karl ; FADEL, Guillaume ; RANDRIANALISOA, Erwan ; CUSQUEL, Sébastien ; Jego, Pierre-Marie ; Guedes, Hélène ; Mercereau, Lina ; Vilanove, Flore ; Peperoni, Marco ; Sely, Aly ; Gantois, Séverine ; Bosq, Elisabeth ; Fontanier, Aurélie ; Morin, Alice ; Cousin, Jocelyne ; Bovagnet, Stéphanie ; Luyt, Charles Edouard ; Hekimian, Guillaume ; Brechot, Nicolas ; Pineton de Chambrun, Marc ; Desnos, Cyrielle ; Chomeloux, Juliette ; Arzoine, Jeremy ; Voiriot, Guillaume ; Baron, Elodie ; Beurton, Alexandra ; Chommeloux, Juliette ; Bay, Pierre ; Demoule, Alexandre ; Guidet, Bertrand ; Constantin, Jean Michel ; Fartoukh, Muriel ; Nataf, Patrick ; Franchineau, Guillaume ; Le Fevre, Lucie ; Raffoul, Richard ; Ghodbane, Walid ; MORDANT, Pierre ; CASTIER, Yves-Hervé ; de MONTMOLLIN, Etienne ; TIMSIT, Jean-François ; Langeron, Olivier ; de Roux, Quentin ; Alessandri, Claire ; Arminot-Frémaux, Margot ; Clariot, Simon ; Kudela, Agathe ; Ly, André ; Meffert, Arnaud ; Skripkina, Elena ; Fiore, Antonio ; Latremouille, Christian ; Mercier, Olaf ; Deleuze, Philippe ; STEPHAN, François ; Duranteau, Jacques ; Richard, Christian ; Monnet, Xavier ; Debbagh, Hassan ; De Wolf, Julien ; Glorion, Matthieu ; Cassiano, Francesco ; Tachon, Guillaume ; Parquin, François ; Zuber, Benjamin ; Voicu, Sébastian ; Deye, Nicolas ; Malissin, Isabelle ; Pépin-Lehalleur, Adrien ; Nguyen, Philippe ; Sidéris, Georgios ; Vodovar, Dominique ; Grant, Caroline ; Gonde, Antoine ; Magalhaes, Adèle ; Nitenberg, Kiyoko ; Marqué, Sophie ; Ensenyat-Martin, Luis ; Delpierre, Eric ; da Silva, Daniel ; Freita-Ramos, Santiago ; Dao, Myriam ; Federici, Laura ; Gaborieau, Baptiste ; Postel-Vinay, Pierre ; Dreyfuss, Didier ; Paris ECMO-COVID-19 investigators</creatorcontrib><description>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.
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.
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.
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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Didier</creatorcontrib><creatorcontrib>Paris ECMO-COVID-19 investigators</creatorcontrib><title>Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study</title><title>The lancet respiratory medicine</title><addtitle>Lancet Respir Med</addtitle><description>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.
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.
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.
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.
None.</description><subject>Cardiology and cardiovascular system</subject><subject>Emerging diseases</subject><subject>Human health and pathology</subject><subject>Infectious diseases</subject><subject>Life Sciences</subject><subject>Pulmonology and respiratory tract</subject><subject>Toxicology</subject><issn>2213-2600</issn><issn>2213-2619</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNqFUt1u0zAUjhCITWOPAPLlJi3DduLU4QI0lf1JlTZpE7eWa5-0hsQuttOtb8OjzmlKBdxwZeuc78fH38my9wSfE0yqjw-UkiKnFcYnlJxijOsqZ6-yw12Z1K_3d4wPsuMQvicQ5rykuHybHRQF5xNaVofZr8vn6KVyfuU8yBZ10M29tIDc82YBVkbjLLIQn5z_gZxfSGvCWJRWI9Uaa1SiuT4q10FAuvfGLlBcAprefbv9mpMarRIUOqOQseg6uUTw6F56E87QVfJS8AlJ1PVtNAps9ICUWzofUYi93rzL3jSyDXC8O4-yx6vLx-lNPru7vp1ezHLFWBFzLQme8BqTYcqqqSXRtGlUSSVWqVWyiVRYca4l502hGU9IwufzSpdcK1kcZZ9H2VU_70BvHyJbsfKmk34jnDTi7441S7Fwa8ExYxRPksDpKLD8h3ZzMRNDDRec8aKu1yRhT3Zm3v3sIUTRmaCgbdPHuz4IyghP8ZV0gLIRqrwLwUOz1yZYDLsgtrsghqAFJWK7C4Il3oc_59mzfiefAF9GAKRPXRvwIigDKQxtPKgotDP_sXgB-2jGdg</recordid><startdate>20210801</startdate><enddate>20210801</enddate><creator>Schmidt, Matthieu</creator><creator>Guihaire, Julien</creator><creator>Cholley, Bernard</creator><creator>Mégarbane, Bruno</creator><creator>Cronier, Pierrick</creator><creator>Da Silva, Daniel</creator><creator>Lacombat, Igor</creator><creator>Duranteau, Jacques</creator><creator>Cerf, Charles</creator><creator>Sonneville, Romain</creator><creator>Longrois, Dan</creator><creator>Leprince, Pascal</creator><creator>SCHOELL, Thibault</creator><creator>MARIN, Sofica</creator><creator>BOUNADER, Karl</creator><creator>FADEL, Guillaume</creator><creator>RANDRIANALISOA, Erwan</creator><creator>CUSQUEL, Sébastien</creator><creator>Jego, Pierre-Marie</creator><creator>Guedes, Hélène</creator><creator>Mercereau, Lina</creator><creator>Vilanove, Flore</creator><creator>Peperoni, Marco</creator><creator>Sely, Aly</creator><creator>Gantois, Séverine</creator><creator>Bosq, Elisabeth</creator><creator>Fontanier, Aurélie</creator><creator>Morin, Alice</creator><creator>Cousin, Jocelyne</creator><creator>Bovagnet, Stéphanie</creator><creator>Luyt, Charles Edouard</creator><creator>Hekimian, Guillaume</creator><creator>Brechot, Nicolas</creator><creator>Pineton de Chambrun, Marc</creator><creator>Desnos, Cyrielle</creator><creator>Chomeloux, Juliette</creator><creator>Arzoine, Jeremy</creator><creator>Voiriot, Guillaume</creator><creator>Baron, Elodie</creator><creator>Beurton, Alexandra</creator><creator>Chommeloux, Juliette</creator><creator>Bay, Pierre</creator><creator>Demoule, Alexandre</creator><creator>Guidet, Bertrand</creator><creator>Constantin, Jean Michel</creator><creator>Fartoukh, Muriel</creator><creator>Nataf, Patrick</creator><creator>Franchineau, Guillaume</creator><creator>Le Fevre, Lucie</creator><creator>Raffoul, Richard</creator><creator>Ghodbane, Walid</creator><creator>MORDANT, Pierre</creator><creator>CASTIER, Yves-Hervé</creator><creator>de MONTMOLLIN, Etienne</creator><creator>TIMSIT, Jean-François</creator><creator>Langeron, Olivier</creator><creator>de Roux, Quentin</creator><creator>Alessandri, Claire</creator><creator>Arminot-Frémaux, Margot</creator><creator>Clariot, Simon</creator><creator>Kudela, Agathe</creator><creator>Ly, André</creator><creator>Meffert, Arnaud</creator><creator>Skripkina, Elena</creator><creator>Fiore, Antonio</creator><creator>Latremouille, Christian</creator><creator>Mercier, Olaf</creator><creator>Deleuze, Philippe</creator><creator>STEPHAN, François</creator><creator>Duranteau, Jacques</creator><creator>Richard, Christian</creator><creator>Monnet, Xavier</creator><creator>Debbagh, Hassan</creator><creator>De Wolf, Julien</creator><creator>Glorion, Matthieu</creator><creator>Cassiano, Francesco</creator><creator>Tachon, Guillaume</creator><creator>Parquin, François</creator><creator>Zuber, Benjamin</creator><creator>Voicu, Sébastian</creator><creator>Deye, Nicolas</creator><creator>Malissin, Isabelle</creator><creator>Pépin-Lehalleur, Adrien</creator><creator>Nguyen, Philippe</creator><creator>Sidéris, Georgios</creator><creator>Vodovar, Dominique</creator><creator>Grant, Caroline</creator><creator>Gonde, Antoine</creator><creator>Magalhaes, Adèle</creator><creator>Nitenberg, Kiyoko</creator><creator>Marqué, Sophie</creator><creator>Ensenyat-Martin, Luis</creator><creator>Delpierre, Eric</creator><creator>da Silva, Daniel</creator><creator>Freita-Ramos, Santiago</creator><creator>Dao, Myriam</creator><creator>Federici, Laura</creator><creator>Gaborieau, Baptiste</creator><creator>Postel-Vinay, Pierre</creator><creator>Dreyfuss, Didier</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>1XC</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6063-7383</orcidid><orcidid>https://orcid.org/0000-0003-2756-4052</orcidid><orcidid>https://orcid.org/0000-0002-6030-3957</orcidid><orcidid>https://orcid.org/0000-0002-2522-2764</orcidid><orcidid>https://orcid.org/0000-0001-7654-474X</orcidid><orcidid>https://orcid.org/0000-0002-7643-6770</orcidid></search><sort><creationdate>20210801</creationdate><title>Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study</title><author>Schmidt, Matthieu ; Guihaire, Julien ; Cholley, Bernard ; Mégarbane, Bruno ; Cronier, Pierrick ; Da Silva, Daniel ; Lacombat, Igor ; Duranteau, Jacques ; Cerf, Charles ; Sonneville, Romain ; Longrois, Dan ; Leprince, Pascal ; SCHOELL, Thibault ; MARIN, Sofica ; BOUNADER, Karl ; FADEL, Guillaume ; RANDRIANALISOA, Erwan ; CUSQUEL, Sébastien ; Jego, Pierre-Marie ; Guedes, Hélène ; Mercereau, Lina ; Vilanove, Flore ; Peperoni, Marco ; Sely, Aly ; Gantois, Séverine ; Bosq, Elisabeth ; Fontanier, Aurélie ; Morin, Alice ; Cousin, Jocelyne ; Bovagnet, Stéphanie ; Luyt, Charles Edouard ; Hekimian, Guillaume ; Brechot, Nicolas ; Pineton de Chambrun, Marc ; Desnos, Cyrielle ; Chomeloux, Juliette ; Arzoine, Jeremy ; Voiriot, Guillaume ; Baron, Elodie ; Beurton, Alexandra ; Chommeloux, Juliette ; Bay, Pierre ; Demoule, Alexandre ; Guidet, Bertrand ; Constantin, Jean Michel ; Fartoukh, Muriel ; Nataf, Patrick ; Franchineau, Guillaume ; Le Fevre, Lucie ; Raffoul, Richard ; Ghodbane, Walid ; MORDANT, Pierre ; CASTIER, Yves-Hervé ; de MONTMOLLIN, Etienne ; TIMSIT, Jean-François ; Langeron, Olivier ; de Roux, Quentin ; Alessandri, Claire ; Arminot-Frémaux, Margot ; Clariot, Simon ; Kudela, Agathe ; Ly, André ; Meffert, Arnaud ; Skripkina, Elena ; Fiore, Antonio ; Latremouille, Christian ; Mercier, Olaf ; Deleuze, Philippe ; STEPHAN, François ; Duranteau, Jacques ; Richard, Christian ; Monnet, Xavier ; Debbagh, Hassan ; De Wolf, Julien ; Glorion, Matthieu ; Cassiano, Francesco ; Tachon, Guillaume ; Parquin, François ; Zuber, Benjamin ; Voicu, Sébastian ; Deye, Nicolas ; Malissin, Isabelle ; Pépin-Lehalleur, Adrien ; Nguyen, Philippe ; Sidéris, Georgios ; Vodovar, Dominique ; Grant, Caroline ; Gonde, Antoine ; Magalhaes, Adèle ; Nitenberg, Kiyoko ; Marqué, Sophie ; Ensenyat-Martin, Luis ; Delpierre, Eric ; da Silva, Daniel ; Freita-Ramos, Santiago ; Dao, Myriam ; Federici, Laura ; Gaborieau, Baptiste ; Postel-Vinay, Pierre ; Dreyfuss, Didier</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c553t-da107890100886f9a1d2ffc42a0ca10457ac0c88da88f3d5801018bb6d48dca3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Cardiology and cardiovascular system</topic><topic>Emerging diseases</topic><topic>Human health and pathology</topic><topic>Infectious diseases</topic><topic>Life Sciences</topic><topic>Pulmonology and respiratory tract</topic><topic>Toxicology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schmidt, Matthieu</creatorcontrib><creatorcontrib>Guihaire, Julien</creatorcontrib><creatorcontrib>Cholley, Bernard</creatorcontrib><creatorcontrib>Mégarbane, Bruno</creatorcontrib><creatorcontrib>Cronier, Pierrick</creatorcontrib><creatorcontrib>Da Silva, Daniel</creatorcontrib><creatorcontrib>Lacombat, Igor</creatorcontrib><creatorcontrib>Duranteau, Jacques</creatorcontrib><creatorcontrib>Cerf, Charles</creatorcontrib><creatorcontrib>Sonneville, Romain</creatorcontrib><creatorcontrib>Longrois, Dan</creatorcontrib><creatorcontrib>Leprince, Pascal</creatorcontrib><creatorcontrib>SCHOELL, Thibault</creatorcontrib><creatorcontrib>MARIN, Sofica</creatorcontrib><creatorcontrib>BOUNADER, Karl</creatorcontrib><creatorcontrib>FADEL, Guillaume</creatorcontrib><creatorcontrib>RANDRIANALISOA, Erwan</creatorcontrib><creatorcontrib>CUSQUEL, Sébastien</creatorcontrib><creatorcontrib>Jego, Pierre-Marie</creatorcontrib><creatorcontrib>Guedes, Hélène</creatorcontrib><creatorcontrib>Mercereau, Lina</creatorcontrib><creatorcontrib>Vilanove, Flore</creatorcontrib><creatorcontrib>Peperoni, Marco</creatorcontrib><creatorcontrib>Sely, Aly</creatorcontrib><creatorcontrib>Gantois, Séverine</creatorcontrib><creatorcontrib>Bosq, Elisabeth</creatorcontrib><creatorcontrib>Fontanier, Aurélie</creatorcontrib><creatorcontrib>Morin, Alice</creatorcontrib><creatorcontrib>Cousin, Jocelyne</creatorcontrib><creatorcontrib>Bovagnet, Stéphanie</creatorcontrib><creatorcontrib>Luyt, Charles Edouard</creatorcontrib><creatorcontrib>Hekimian, Guillaume</creatorcontrib><creatorcontrib>Brechot, Nicolas</creatorcontrib><creatorcontrib>Pineton de Chambrun, Marc</creatorcontrib><creatorcontrib>Desnos, Cyrielle</creatorcontrib><creatorcontrib>Chomeloux, Juliette</creatorcontrib><creatorcontrib>Arzoine, Jeremy</creatorcontrib><creatorcontrib>Voiriot, Guillaume</creatorcontrib><creatorcontrib>Baron, Elodie</creatorcontrib><creatorcontrib>Beurton, Alexandra</creatorcontrib><creatorcontrib>Chommeloux, Juliette</creatorcontrib><creatorcontrib>Bay, Pierre</creatorcontrib><creatorcontrib>Demoule, Alexandre</creatorcontrib><creatorcontrib>Guidet, Bertrand</creatorcontrib><creatorcontrib>Constantin, Jean Michel</creatorcontrib><creatorcontrib>Fartoukh, Muriel</creatorcontrib><creatorcontrib>Nataf, Patrick</creatorcontrib><creatorcontrib>Franchineau, Guillaume</creatorcontrib><creatorcontrib>Le Fevre, Lucie</creatorcontrib><creatorcontrib>Raffoul, Richard</creatorcontrib><creatorcontrib>Ghodbane, Walid</creatorcontrib><creatorcontrib>MORDANT, Pierre</creatorcontrib><creatorcontrib>CASTIER, Yves-Hervé</creatorcontrib><creatorcontrib>de MONTMOLLIN, Etienne</creatorcontrib><creatorcontrib>TIMSIT, Jean-François</creatorcontrib><creatorcontrib>Langeron, Olivier</creatorcontrib><creatorcontrib>de Roux, Quentin</creatorcontrib><creatorcontrib>Alessandri, Claire</creatorcontrib><creatorcontrib>Arminot-Frémaux, Margot</creatorcontrib><creatorcontrib>Clariot, Simon</creatorcontrib><creatorcontrib>Kudela, Agathe</creatorcontrib><creatorcontrib>Ly, André</creatorcontrib><creatorcontrib>Meffert, Arnaud</creatorcontrib><creatorcontrib>Skripkina, Elena</creatorcontrib><creatorcontrib>Fiore, Antonio</creatorcontrib><creatorcontrib>Latremouille, Christian</creatorcontrib><creatorcontrib>Mercier, Olaf</creatorcontrib><creatorcontrib>Deleuze, Philippe</creatorcontrib><creatorcontrib>STEPHAN, François</creatorcontrib><creatorcontrib>Duranteau, Jacques</creatorcontrib><creatorcontrib>Richard, Christian</creatorcontrib><creatorcontrib>Monnet, Xavier</creatorcontrib><creatorcontrib>Debbagh, Hassan</creatorcontrib><creatorcontrib>De Wolf, Julien</creatorcontrib><creatorcontrib>Glorion, Matthieu</creatorcontrib><creatorcontrib>Cassiano, Francesco</creatorcontrib><creatorcontrib>Tachon, Guillaume</creatorcontrib><creatorcontrib>Parquin, François</creatorcontrib><creatorcontrib>Zuber, Benjamin</creatorcontrib><creatorcontrib>Voicu, Sébastian</creatorcontrib><creatorcontrib>Deye, Nicolas</creatorcontrib><creatorcontrib>Malissin, Isabelle</creatorcontrib><creatorcontrib>Pépin-Lehalleur, Adrien</creatorcontrib><creatorcontrib>Nguyen, Philippe</creatorcontrib><creatorcontrib>Sidéris, Georgios</creatorcontrib><creatorcontrib>Vodovar, Dominique</creatorcontrib><creatorcontrib>Grant, Caroline</creatorcontrib><creatorcontrib>Gonde, Antoine</creatorcontrib><creatorcontrib>Magalhaes, Adèle</creatorcontrib><creatorcontrib>Nitenberg, Kiyoko</creatorcontrib><creatorcontrib>Marqué, Sophie</creatorcontrib><creatorcontrib>Ensenyat-Martin, Luis</creatorcontrib><creatorcontrib>Delpierre, Eric</creatorcontrib><creatorcontrib>da Silva, Daniel</creatorcontrib><creatorcontrib>Freita-Ramos, Santiago</creatorcontrib><creatorcontrib>Dao, Myriam</creatorcontrib><creatorcontrib>Federici, Laura</creatorcontrib><creatorcontrib>Gaborieau, Baptiste</creatorcontrib><creatorcontrib>Postel-Vinay, Pierre</creatorcontrib><creatorcontrib>Dreyfuss, Didier</creatorcontrib><creatorcontrib>Paris ECMO-COVID-19 investigators</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The lancet respiratory medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schmidt, Matthieu</au><au>Guihaire, Julien</au><au>Cholley, Bernard</au><au>Mégarbane, Bruno</au><au>Cronier, Pierrick</au><au>Da Silva, Daniel</au><au>Lacombat, Igor</au><au>Duranteau, Jacques</au><au>Cerf, Charles</au><au>Sonneville, Romain</au><au>Longrois, Dan</au><au>Leprince, Pascal</au><au>SCHOELL, Thibault</au><au>MARIN, Sofica</au><au>BOUNADER, Karl</au><au>FADEL, Guillaume</au><au>RANDRIANALISOA, Erwan</au><au>CUSQUEL, Sébastien</au><au>Jego, Pierre-Marie</au><au>Guedes, Hélène</au><au>Mercereau, Lina</au><au>Vilanove, Flore</au><au>Peperoni, Marco</au><au>Sely, Aly</au><au>Gantois, Séverine</au><au>Bosq, Elisabeth</au><au>Fontanier, Aurélie</au><au>Morin, Alice</au><au>Cousin, Jocelyne</au><au>Bovagnet, Stéphanie</au><au>Luyt, Charles Edouard</au><au>Hekimian, Guillaume</au><au>Brechot, Nicolas</au><au>Pineton de Chambrun, Marc</au><au>Desnos, Cyrielle</au><au>Chomeloux, Juliette</au><au>Arzoine, Jeremy</au><au>Voiriot, Guillaume</au><au>Baron, Elodie</au><au>Beurton, Alexandra</au><au>Chommeloux, Juliette</au><au>Bay, Pierre</au><au>Demoule, Alexandre</au><au>Guidet, Bertrand</au><au>Constantin, Jean Michel</au><au>Fartoukh, Muriel</au><au>Nataf, Patrick</au><au>Franchineau, Guillaume</au><au>Le Fevre, Lucie</au><au>Raffoul, Richard</au><au>Ghodbane, Walid</au><au>MORDANT, Pierre</au><au>CASTIER, Yves-Hervé</au><au>de MONTMOLLIN, Etienne</au><au>TIMSIT, Jean-François</au><au>Langeron, Olivier</au><au>de Roux, Quentin</au><au>Alessandri, Claire</au><au>Arminot-Frémaux, Margot</au><au>Clariot, Simon</au><au>Kudela, Agathe</au><au>Ly, André</au><au>Meffert, Arnaud</au><au>Skripkina, Elena</au><au>Fiore, Antonio</au><au>Latremouille, Christian</au><au>Mercier, Olaf</au><au>Deleuze, Philippe</au><au>STEPHAN, François</au><au>Duranteau, Jacques</au><au>Richard, Christian</au><au>Monnet, Xavier</au><au>Debbagh, Hassan</au><au>De Wolf, Julien</au><au>Glorion, Matthieu</au><au>Cassiano, Francesco</au><au>Tachon, Guillaume</au><au>Parquin, François</au><au>Zuber, Benjamin</au><au>Voicu, Sébastian</au><au>Deye, Nicolas</au><au>Malissin, Isabelle</au><au>Pépin-Lehalleur, Adrien</au><au>Nguyen, Philippe</au><au>Sidéris, Georgios</au><au>Vodovar, Dominique</au><au>Grant, Caroline</au><au>Gonde, Antoine</au><au>Magalhaes, Adèle</au><au>Nitenberg, Kiyoko</au><au>Marqué, Sophie</au><au>Ensenyat-Martin, Luis</au><au>Delpierre, Eric</au><au>da Silva, Daniel</au><au>Freita-Ramos, Santiago</au><au>Dao, Myriam</au><au>Federici, Laura</au><au>Gaborieau, Baptiste</au><au>Postel-Vinay, Pierre</au><au>Dreyfuss, Didier</au><aucorp>Paris ECMO-COVID-19 investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study</atitle><jtitle>The lancet respiratory medicine</jtitle><addtitle>Lancet Respir Med</addtitle><date>2021-08-01</date><risdate>2021</risdate><volume>9</volume><issue>8</issue><spage>851</spage><epage>862</epage><pages>851-862</pages><issn>2213-2600</issn><eissn>2213-2619</eissn><abstract>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.
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.
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.
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.
None.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>33887246</pmid><doi>10.1016/S2213-2600(21)00096-5</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-6063-7383</orcidid><orcidid>https://orcid.org/0000-0003-2756-4052</orcidid><orcidid>https://orcid.org/0000-0002-6030-3957</orcidid><orcidid>https://orcid.org/0000-0002-2522-2764</orcidid><orcidid>https://orcid.org/0000-0001-7654-474X</orcidid><orcidid>https://orcid.org/0000-0002-7643-6770</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2213-2600 |
| ispartof | The lancet respiratory medicine, 2021-08, Vol.9 (8), p.851-862 |
| issn | 2213-2600 2213-2619 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8055207 |
| source | Alma/SFX Local Collection |
| subjects | Cardiology and cardiovascular system Emerging diseases Human health and pathology Infectious diseases Life Sciences Pulmonology and respiratory tract Toxicology |
| title | Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study |
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