Extracorporeal Membrane Oxygenation for Severe MERS - CoV: A Retrospective Observational Study
CCCF ePoster library. Lewis K. Nov 1, 2016; 150946; 66
Kim Lewis
Kim Lewis
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#66

Topic: Retrospective or Prospective Cohort Study

Extracorporeal Membrane Oxygenation for Severe MERS - CoV: A Retrospective Observational Study


Alshahrani, Mohammed1; Sindi, Anees2; Lewis, Kim3; Alshamsi, Fayez4; Alomari, Awad5; ElTahan, Mohamed6; Alahmadi, Bayan7; Zein, Ahmed8; Khatani, Naif9; Alhameed, Fahad10; Alamri, Sultan11; Abdelzaher, Mohammed12; Alghamdi, Amenah13; Alfousan, Faisal14; Tash, Adel15; Tashkandi, Wail16; Alraddadi, Rajaa17;  Arabi, Yaseen18; Fan, Eddy19; Alhazzani, Waleed20

1Department of Emergency and Critical Care Medicine, King Fahad Hospital of the University-University of Dammam, Dammam, Saudi Arabia; 2Department of Anesthesia and Critical Care Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Medicine, McMaster University, Hamilton, Canada; 4Department of Medicine, McMaster University, Hamilton, Canada; 5Sulaiman Alhabeeb Hospital, Riyadh, Saudi Arabia; 6Cardiothoracic Anaesthesia & Surgical Intensive Care, University of Dammam, Dammam, Saudi Arabia; 7Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 8Intensive Care Department, King Fahad Hospital, Jeddah, Saudi Arabia; 9Department of Internal Medicine, King Abdulaziz University, Jeddah Saudi Arabia; 10Pulmonary and Critical Care Medicine, Department of Intensive Care, College of Medicine, King Saud bin Abdulaziz University for Health Sciences,  King  Abdulaziz Medical  City,  National  Guard  Health  Affairs,  Jeddah, Saudi Arabia; 11Department of Intensive Care Unit, National Hospital, Riyadh, Saudi Arabia; 12Critical Care Medicine Department, Cairo University Hospitals, Egypt; 13Department of Internal Medicine, King Abdulaziz University, Jeddah Saudi Arabia; 14Department of Internal Medicine, King Abdulaziz University, Jeddah Saudi Arabia; 15Department of Cardiac Surgery, King Abdullah Medical City, Makkah, Saudi Arabia; 16General Surgery & Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia; 17Community Medicine, Ministry of Health, Saudi Arabia; 18King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 19University of Toronto, Canada; 20Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada

 



Abstract:

 Introduction 

Middle East Respiratory Syndrome (MERS) is a viral infection caused by a coronavirus (MERS-CoV) characterized by hypoxemic respiratory failure and organ dysfunction. Extracorporeal Membrane Oxygenation (ECMO) was not widely available for patients with refractory hypoxia prior to April 2014 in Saudi Arabia; however, several ECMO programs were launched in response to the large outbreak in April 2014. We therefore compared the outcomes of MERS-CoV patients before and after the availability of ECMO as a rescue therapy in severely hypoxemic patients who failed conventional strategies.

Method:

Data were retrospectively collected on patients with confirmed MERS-CoV infection who developed severe refractory hypoxemic respiratory failure from April to December 2014 in intensive care units (ICUs) in 5 hospitals in Saudi Arabia. They were divided into two groups: ECMO group (patients with MERS-CoV with severe hypoxemia who received ECMO as a rescue therapy) vs control group (patients with MERS-CoV and severe hypoxemia prior to ECMO services in Saudi Arabia). Our primary outcome is hospital mortality; secondary outcomes included hospital and ICU length of stay.

Results:

We included 35 patients who met eligibility criteria, 17 patients received ECMO and 18 were in the control group. Both groups were comparable regarding demographic data, co-morbidities, and severity of illness. Patients who were treated with ECMO had lower in-hospital mortality (64.7% vs. 100%, P = 0.02), longer ICU stay (median 24.8 days vs. 8.1 days, respectively, P = 0.001), and similar hospital stay (median 40.8 vs. 31.1 days, P = 0.421). ECMO patients had better PaO2/FiO2 at days 7 and 14 of admission to the ICU (124 vs. 63, and 138 vs. 36, respectively, P <0.05), less use of norepinephrine at days 1 and 14 (29.4% vs. 80%; and 35.7% vs. 92.9%, respectively, P < 0.05).

Conclusion:

Our study shows that ECMO use, as rescue therapy was associated with lower mortality in MERS patients with refractory hypoxemia. The results of this, largest to date, observational study support the use of ECMO as a rescue therapy in patients with severe MERS-CoV.  


References:

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