ObjectiveDescribe the clinical and respiratory characteristics of critical patients with coronavirus disease 2019 (COVID-19).DesignObservational and retrospective study over 6 months.SettingIntensive care unit (ICU) of a high complexity hospital in Buenos Aires, Argentina.PatientsPatients older than 18 years with laboratory-confirmed COVID-19 by reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2 were included in the study.Variables of interestDemographic characteristics such as sex and age, comorbidities, laboratory results, imaging results, ventilatory mechanics data, complications, and mortality were recorded.ResultsA total of 168 critically ill patients with COVID-19 were included. 66% were men with a median age of 65 years (58-75. 79.7% had at least one comorbidity. The most frequent comorbidity was arterial hypertension, affecting 52.4% of the patients. 67.9 % required invasive mechanical ventilation (MV), and no patient was treated with non-invasive ventilation. Most of the patients in MV (73.7%) required neuromuscular blockade due to severe hypoxemia. 36% of patients were ventilated in the prone position. The length of stay in the ICU was 13 days (6-24) and the mortality in the ICU was 25%.ConclusionsIn this study of critical patients infected by SARS-CoV-2 in a high-complexity hospital, the majority were comorbid elderly men, a large percentage required invasive mechanical ventilation, and ICU mortality was 25%.

Background The criteria for the selection of COVID‐19 patients that could benefit most from ECMO organ support are yet to be defined. In this study, we evaluated the predictive performance of ECMO mortality predictive models in patients with COVID‐19. We also performed a cost–benefit analysis depending on the mortality predicted probability. We conducted a retrospective cohort study in COVID‐19 patients who received ECMO at two tertiary care hospitals between March 2020 to July 2021. Materials and Methods We evaluated the discrimination (C‐statistic), calibration (Cox calibration), and accuracy of the prediction of death due to severe ARDS in V‐V ECMO score (PRESERVE), the Respiratory Extracorporeal Membrane Oxygenation Survival Score (RESP) score, and the PREdiction of Survival on ECMO Therapy‐Score (PRESET) score. In addition, we compared the RESP score with Plateau pressure instead of Peak pressure. Results We included a total of 36 patients, 29 (80%) of them male and with a median (IQR) APACHE of 10 (8–15). The PRESET score had the highest discrimination (AUROCs 0.81 [95%CI 0.67–0.94]) and calibration (calibration‐in‐the‐large 0.5 [95%CI −1.4 to 0.3]; calibration slope 2.2 [95%CI 0.7/3.7]). The RESP score with Plateau pressure had higher discrimination than the conventional RESP score. The cost per QALY in the USA, adjusted to life expectancy, was higher than USD 100 000 in patients older than 45 years with a PRESET > 10. Conclusion The PRESET score had the highest predictive performance and could help in the selection of patients that benefit most from this resource‐demanding and highly invasive organ support.

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Introducción: El uso de membrana de circulación extracorpórea (ECMO) en pacientes con síndrome de distrés respiratorio agudo (SDRA) es una medida de rescate que busca optimizar la oxigenación como puente a la rehabilitación pulmonar. Su rol en la enfermedad por coronavirus (COVID-19) no está definido, sin embargo, en pacientes con insuficiencia respiratoria hipoxémica refractaria, y con potencial de recuperación, su uso podría resultar beneficioso. Objetivo: El propósito de este trabajo es informar el primer caso de COVID-19 que requirió ECMO en Argentina, con buena respuesta. Metodología:  Se  describe el  primer  caso de COVID-19 que requirió ECMO en Argentina, en  un paciente sin comorbilidades, con buen resultado clínico.  Resultados: El uso de ECMO en el caso reportado aportó un sustancial beneficio en la oxigenación actuando como puente a la recuperación pulmonar, sin presentar complicaciones asociadas a su aplicación. Conclusión: En pacientes críticamente enfermos con hipoxemia refractaria, pero con potencial de recuperación, el soporte con ECMO puede ser considerado como una medida de rescate.

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