Outcomes of severe systemic rheumatic disease patients requiring extracorporeal membrane oxygenation
Abstract Background Systemic 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...
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2021-02-01
|
| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13613-021-00819-3 |
| _version_ | 1818677094547193856 |
|---|---|
| author | Pierre Bay Guillaume Lebreton Alexis Mathian Pierre Demondion Cyrielle Desnos Juliette Chommeloux Guillaume Hékimian Nicolas Bréchot Ania Nieszkowska Matthieu Schmidt Fleur Cohen-Aubart Pascal Leprince Charles-Edouard Luyt Zahir Amoura Alain Combes Marc Pineton de Chambrun |
| author_facet | Pierre Bay Guillaume Lebreton Alexis Mathian Pierre Demondion Cyrielle Desnos Juliette Chommeloux Guillaume Hékimian Nicolas Bréchot Ania Nieszkowska Matthieu Schmidt Fleur Cohen-Aubart Pascal Leprince Charles-Edouard Luyt Zahir Amoura Alain Combes Marc Pineton de Chambrun |
| author_sort | Pierre Bay |
| collection | DOAJ |
| description | Abstract Background Systemic 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. Methods This 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. Results Ninety 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. Conclusions ECMO 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. |
| first_indexed | 2024-12-17T08:53:54Z |
| format | Article |
| id | doaj.art-549cb72c9a0341539ade8a83cb7fa783 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-17T08:53:54Z |
| publishDate | 2021-02-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-549cb72c9a0341539ade8a83cb7fa7832022-12-21T21:56:01ZengSpringerOpenAnnals of Intensive Care2110-58202021-02-0111111110.1186/s13613-021-00819-3Outcomes of severe systemic rheumatic disease patients requiring extracorporeal membrane oxygenationPierre Bay0Guillaume Lebreton1Alexis Mathian2Pierre Demondion3Cyrielle Desnos4Juliette Chommeloux5Guillaume Hékimian6Nicolas Bréchot7Ania Nieszkowska8Matthieu Schmidt9Fleur Cohen-Aubart10Pascal Leprince11Charles-Edouard Luyt12Zahir Amoura13Alain Combes14Marc Pineton de Chambrun15Service de Médecine Intensive-Réanimation, Hôpital La Pitié–Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP)Service de Chirurgie Cardiothoracique, Hôpital La Pitié–Salpêtrière, Institut de Cardiologie, Sorbonne Université, APHPService de Médecine Interne 2, Institut E3M, Sorbonne Université, Hôpital La Pitié–SalpêtrièreService de Chirurgie Cardiothoracique, Hôpital La Pitié–Salpêtrière, Institut de Cardiologie, Sorbonne Université, APHPService de Médecine Intensive-Réanimation, Hôpital La Pitié–Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP)Service de Médecine Intensive-Réanimation, Hôpital La Pitié–Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP)Service de Médecine Intensive-Réanimation, Hôpital La Pitié–Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP)Service de Médecine Intensive-Réanimation, Hôpital La Pitié–Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP)Service de Médecine Intensive-Réanimation, Hôpital La Pitié–Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP)Service de Médecine Intensive-Réanimation, Hôpital La Pitié–Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP)Service de Médecine Interne 2, Institut E3M, Sorbonne Université, Hôpital La Pitié–SalpêtrièreService de Chirurgie Cardiothoracique, Hôpital La Pitié–Salpêtrière, Institut de Cardiologie, Sorbonne Université, APHPService de Médecine Intensive-Réanimation, Hôpital La Pitié–Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP)Service de Médecine Interne 2, Institut E3M, Sorbonne Université, Hôpital La Pitié–SalpêtrièreService de Médecine Intensive-Réanimation, Hôpital La Pitié–Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP)Service de Médecine Intensive-Réanimation, Hôpital La Pitié–Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP)Abstract Background Systemic 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. Methods This 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. Results Ninety 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. Conclusions ECMO 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.https://doi.org/10.1186/s13613-021-00819-3Systemic rheumatic diseaseExtracorporeal membrane oxygenationIntensive care unitVasculitisSystemic lupus erythematosusConnective tissue disease |
| spellingShingle | Pierre Bay Guillaume Lebreton Alexis Mathian Pierre Demondion Cyrielle Desnos Juliette Chommeloux Guillaume Hékimian Nicolas Bréchot Ania Nieszkowska Matthieu Schmidt Fleur Cohen-Aubart Pascal Leprince Charles-Edouard Luyt Zahir Amoura Alain Combes Marc Pineton de Chambrun Outcomes of severe systemic rheumatic disease patients requiring extracorporeal membrane oxygenation Annals of Intensive Care Systemic rheumatic disease Extracorporeal membrane oxygenation Intensive care unit Vasculitis Systemic lupus erythematosus Connective tissue disease |
| title | Outcomes of severe systemic rheumatic disease patients requiring extracorporeal membrane oxygenation |
| title_full | Outcomes of severe systemic rheumatic disease patients requiring extracorporeal membrane oxygenation |
| title_fullStr | Outcomes of severe systemic rheumatic disease patients requiring extracorporeal membrane oxygenation |
| title_full_unstemmed | Outcomes of severe systemic rheumatic disease patients requiring extracorporeal membrane oxygenation |
| title_short | Outcomes of severe systemic rheumatic disease patients requiring extracorporeal membrane oxygenation |
| title_sort | outcomes of severe systemic rheumatic disease patients requiring extracorporeal membrane oxygenation |
| topic | Systemic rheumatic disease Extracorporeal membrane oxygenation Intensive care unit Vasculitis Systemic lupus erythematosus Connective tissue disease |
| url | https://doi.org/10.1186/s13613-021-00819-3 |
| work_keys_str_mv | AT pierrebay outcomesofseveresystemicrheumaticdiseasepatientsrequiringextracorporealmembraneoxygenation AT guillaumelebreton outcomesofseveresystemicrheumaticdiseasepatientsrequiringextracorporealmembraneoxygenation AT alexismathian outcomesofseveresystemicrheumaticdiseasepatientsrequiringextracorporealmembraneoxygenation AT pierredemondion outcomesofseveresystemicrheumaticdiseasepatientsrequiringextracorporealmembraneoxygenation AT cyrielledesnos outcomesofseveresystemicrheumaticdiseasepatientsrequiringextracorporealmembraneoxygenation AT juliettechommeloux outcomesofseveresystemicrheumaticdiseasepatientsrequiringextracorporealmembraneoxygenation AT guillaumehekimian outcomesofseveresystemicrheumaticdiseasepatientsrequiringextracorporealmembraneoxygenation AT nicolasbrechot outcomesofseveresystemicrheumaticdiseasepatientsrequiringextracorporealmembraneoxygenation AT anianieszkowska outcomesofseveresystemicrheumaticdiseasepatientsrequiringextracorporealmembraneoxygenation AT matthieuschmidt outcomesofseveresystemicrheumaticdiseasepatientsrequiringextracorporealmembraneoxygenation AT fleurcohenaubart outcomesofseveresystemicrheumaticdiseasepatientsrequiringextracorporealmembraneoxygenation AT pascalleprince outcomesofseveresystemicrheumaticdiseasepatientsrequiringextracorporealmembraneoxygenation AT charlesedouardluyt outcomesofseveresystemicrheumaticdiseasepatientsrequiringextracorporealmembraneoxygenation AT zahiramoura outcomesofseveresystemicrheumaticdiseasepatientsrequiringextracorporealmembraneoxygenation AT alaincombes outcomesofseveresystemicrheumaticdiseasepatientsrequiringextracorporealmembraneoxygenation AT marcpinetondechambrun outcomesofseveresystemicrheumaticdiseasepatientsrequiringextracorporealmembraneoxygenation |