The teams of the cardiac and thoracic surgery departments (Prof. Pascal Leprince, Dr Guillaume Lebreton), and intensive medicine-intensive care (Prof. Alain Combes) of the Pitié-Salpêtrière hospital AP-HP, Sorbonne University and the Inserm, reported the results of the ECMO in the care of patients with extremely serious respiratory damage caused by Covid-19, and the regional organization set up by the Ile-de- France to deal with the pandemic. This work is the subject of a publication on April 19, 2021, in the Lancet Respiratory .
In extremely serious respiratory disorders (ARDS) escaping conventional resuscitation techniques, ECMO (extracorporeal membrane oxygenation) can be used to ensure oxygenation of the blood while awaiting healing of the lungs.
At the start of the Covid-19 pandemic, it was not certain that ECMO could be used for the care of patients with extremely serious respiratory damage caused by Covid-19. Very quickly, in Ile-de-France, a group of experts met to reflect on the place that ECMO could have in this indication, but also on the organization to be put in place to be able to cope with this indication. crisis. Regional regulation has been put in place by ARS Ile-de-France, in conjunction with all stakeholders, to centralize indications and pool resources. A regional doctrine has been developed and published in this direction.
In this multicenter cohort study, the authors present an analysis of all adult patients with laboratory-confirmed Covid-19 infection and severe ARDS requiring ECMO, who were admitted to 17 care units intensive in Ile-de-France between March 8 and June 3, 2020.
During the first wave, six ECMO mobile teams were formed and 17 resuscitations with ECMO experience were identified. 302 patients were thus able to be assisted by ECMO throughout the region, whether or not they were taken care of in intensive care units equipped with ECMO thanks to the mobile teams (mobile circulatory assistance units). These UMACs ensured the establishment of the ECMO then the transfer (55% of patients) of the patient to a specialized intensive care unit.
The analysis of the results at 90 days shows a survival of 46% for these most serious patients with a predictable survival without ECMO almost zero. The age of the patients, the duration of mechanical ventilation before ECMO, renal impairment and the volume of ECMO of the centers appeared to be prognostic factors. The results of cannulation of the patient by a mobile team and then transfer to ECMO in a specialized intensive care unit were not significantly different from those of patients cannulated in a center with ECMO, which validates the concept of a mobile unit. circulatory assistance (UMAC).
Regional regulation, pooling of resources and centralization of indications made it possible to effectively cope with the first wave of Covid-19 by assisting patients requiring ECMO in the Ile-de-France region, regardless of their hospital of origin. After this experience, this organizational model was extended for the following waves.
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Guillaume Lebreton, MD – Matthieu Schmidt, MD – Maharajah Ponnaiah, PhD – Prof Thierry Folliguet, MD – Marylou Para, MD – Julien Guihaire, MD – Emmanuel Lansac, MD – Prof Edouard Sage, MD – Prof Bernard Cholley, MD – Prof Bruno Mégarbane, MD – Pierrick Cronier, MD – Jonathan Zarka, MD – Daniel Da Silva, MD – Sebastien Besset, MD – Igor Lacombat, MD – Prof Nicolas Mongardon, MD – Prof Christian Richard, MD – Prof Jacques Duranteau, MD – Charles Cerf, MD – Gabriel Saiydoun, MD – Prof Romain Sonneville, MD – Prof Jean-Daniel Chiche, MD – Prof Patrick Nataf, MD – Prof Dan Longrois, MD – Prof Alain Combes, MD – Prof Pascal Leprince, MD – and theParis ECMO-COVID-19 investigators †.
The Lancet Respiratory.