Dismal Survival in COVID-19 Patients Requiring ECMO as Rescue Therapy after Corticosteroid Failure

<b>(1)</b> Background: COVID-19 may lead to refractory hypoxemia requiring venovenous extracorporeal membrane oxygenation (ECMO). Survival rate if ECMO is implemented as rescue therapy after corticosteroid failure is unknown. We aimed to investigate if ECMO implemented after failure of t...

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Autores principales:	Sebastian Voicu, Antoine Goury, Thomas Lacoste-Palasset, Isabelle Malissin, Lucie Fanet, Samar Souissi, Julia Busto, Vincent Legros, Laetitia Sutterlin, Giulia Naim, Aymen M’Rad, Adrien Pepin-Lehaleur, Nicolas Deye, Bruno Mourvillier, Bruno Mégarbane
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	ARDS COVID-19 corticosteroid dexamethasone ECMO survival Medicine R
Acceso en línea:	https://doaj.org/article/b6c67274e7494f4b9bce80ecc7e3023b
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spelling	oai:doaj.org-article:b6c67274e7494f4b9bce80ecc7e3023b2021-11-25T18:08:16ZDismal Survival in COVID-19 Patients Requiring ECMO as Rescue Therapy after Corticosteroid Failure10.3390/jpm111112382075-4426https://doaj.org/article/b6c67274e7494f4b9bce80ecc7e3023b2021-11-01T00:00:00Zhttps://www.mdpi.com/2075-4426/11/11/1238https://doaj.org/toc/2075-4426<b>(1)</b> Background: COVID-19 may lead to refractory hypoxemia requiring venovenous extracorporeal membrane oxygenation (ECMO). Survival rate if ECMO is implemented as rescue therapy after corticosteroid failure is unknown. We aimed to investigate if ECMO implemented after failure of the full-recommended 10-day corticosteroid course can improve outcome. <b>(2)</b> Methods: We conducted a three-center cohort study including consecutive dexamethasone-treated COVID-19 patients requiring ECMO between 03/2020 and 05/2021. We compared survival at hospital discharge between patients implemented after (<i>ECMO-after</i> group) and before the end of the 10-day dexamethasone course (<i>ECMO-before</i> group). <b>(3)</b> Results: Forty patients (28M/12F; age, 57 years (51–62) (median (25th–75th percentiles)) were included, 28 (70%) in the <i>ECMO-before</i> and 12 (30%) in the <i>ECMO-after</i> group. In the <i>ECMO-before</i> group, 9/28 patients (32%) received the 6 mg/day dexamethasone regimen versus 12/12 (100%) in the <i>ECMO-after</i> group (<i>p</i> < 0.0001). The rest of the patients received an alternative dexamethasone regimen consisting of 20 mg/day during 5 days followed by 10 mg/day during 5 days. Patients in the <i>ECMO-before</i> group tended to be younger (57 years (51–59) versus 62 years (57–67), <i>p</i> = 0.053). In the <i>ECMO-after</i> group, no patient (0%) survived while 12 patients (43%) survived in the <i>ECMO-before</i> group (<i>p</i> = 0.007). <b>(4)</b> Conclusions: Survival is poor in COVID-19 patients requiring ECMO implemented after the full-recommended 10-day dexamethasone course. Since these patients may have developed a particularly severe presentation, new therapeutic strategies are urgently required.Sebastian VoicuAntoine GouryThomas Lacoste-PalassetIsabelle MalissinLucie FanetSamar SouissiJulia BustoVincent LegrosLaetitia SutterlinGiulia NaimAymen M’RadAdrien Pepin-LehaleurNicolas DeyeBruno MourvillierBruno MégarbaneMDPI AGarticleARDSCOVID-19corticosteroiddexamethasoneECMOsurvivalMedicineRENJournal of Personalized Medicine, Vol 11, Iss 1238, p 1238 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	ARDS COVID-19 corticosteroid dexamethasone ECMO survival Medicine R
spellingShingle	ARDS COVID-19 corticosteroid dexamethasone ECMO survival Medicine R Sebastian Voicu Antoine Goury Thomas Lacoste-Palasset Isabelle Malissin Lucie Fanet Samar Souissi Julia Busto Vincent Legros Laetitia Sutterlin Giulia Naim Aymen M’Rad Adrien Pepin-Lehaleur Nicolas Deye Bruno Mourvillier Bruno Mégarbane Dismal Survival in COVID-19 Patients Requiring ECMO as Rescue Therapy after Corticosteroid Failure
description	<b>(1)</b> Background: COVID-19 may lead to refractory hypoxemia requiring venovenous extracorporeal membrane oxygenation (ECMO). Survival rate if ECMO is implemented as rescue therapy after corticosteroid failure is unknown. We aimed to investigate if ECMO implemented after failure of the full-recommended 10-day corticosteroid course can improve outcome. <b>(2)</b> Methods: We conducted a three-center cohort study including consecutive dexamethasone-treated COVID-19 patients requiring ECMO between 03/2020 and 05/2021. We compared survival at hospital discharge between patients implemented after (<i>ECMO-after</i> group) and before the end of the 10-day dexamethasone course (<i>ECMO-before</i> group). <b>(3)</b> Results: Forty patients (28M/12F; age, 57 years (51–62) (median (25th–75th percentiles)) were included, 28 (70%) in the <i>ECMO-before</i> and 12 (30%) in the <i>ECMO-after</i> group. In the <i>ECMO-before</i> group, 9/28 patients (32%) received the 6 mg/day dexamethasone regimen versus 12/12 (100%) in the <i>ECMO-after</i> group (<i>p</i> < 0.0001). The rest of the patients received an alternative dexamethasone regimen consisting of 20 mg/day during 5 days followed by 10 mg/day during 5 days. Patients in the <i>ECMO-before</i> group tended to be younger (57 years (51–59) versus 62 years (57–67), <i>p</i> = 0.053). In the <i>ECMO-after</i> group, no patient (0%) survived while 12 patients (43%) survived in the <i>ECMO-before</i> group (<i>p</i> = 0.007). <b>(4)</b> Conclusions: Survival is poor in COVID-19 patients requiring ECMO implemented after the full-recommended 10-day dexamethasone course. Since these patients may have developed a particularly severe presentation, new therapeutic strategies are urgently required.
format	article
author	Sebastian Voicu Antoine Goury Thomas Lacoste-Palasset Isabelle Malissin Lucie Fanet Samar Souissi Julia Busto Vincent Legros Laetitia Sutterlin Giulia Naim Aymen M’Rad Adrien Pepin-Lehaleur Nicolas Deye Bruno Mourvillier Bruno Mégarbane
author_facet	Sebastian Voicu Antoine Goury Thomas Lacoste-Palasset Isabelle Malissin Lucie Fanet Samar Souissi Julia Busto Vincent Legros Laetitia Sutterlin Giulia Naim Aymen M’Rad Adrien Pepin-Lehaleur Nicolas Deye Bruno Mourvillier Bruno Mégarbane
author_sort	Sebastian Voicu
title	Dismal Survival in COVID-19 Patients Requiring ECMO as Rescue Therapy after Corticosteroid Failure
title_short	Dismal Survival in COVID-19 Patients Requiring ECMO as Rescue Therapy after Corticosteroid Failure
title_full	Dismal Survival in COVID-19 Patients Requiring ECMO as Rescue Therapy after Corticosteroid Failure
title_fullStr	Dismal Survival in COVID-19 Patients Requiring ECMO as Rescue Therapy after Corticosteroid Failure
title_full_unstemmed	Dismal Survival in COVID-19 Patients Requiring ECMO as Rescue Therapy after Corticosteroid Failure
title_sort	dismal survival in covid-19 patients requiring ecmo as rescue therapy after corticosteroid failure
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/b6c67274e7494f4b9bce80ecc7e3023b
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Dismal Survival in COVID-19 Patients Requiring ECMO as Rescue Therapy after Corticosteroid Failure

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