Early Bacterial Identification among Intubated Patients with COVID-19 or Influenza Pneumonia: A European Multicenter Comparative Clinical Trial

Rouzé, Anahita; Martín‐Loeches, Ignacio; Póvoa, Pedro; Metzelard, Matthieu; Cheyron, Damien du; Lambiotte, Fabien; Tamion, Fabienne; Labruyère, Marie; Geronimi, Claire Boulle; Nieszkowska, Ania; Nyunga, Martine; Pouly, Olivier; Thille, Arnaud W.; Mégarbane, Bruno; Saade, Anastasia; Dı́az, Emili; Magira, Eleni; Llitjos, Jean-François; Cillóniz, Catia; Ioannidou, Iliana; Pierre, Alexandre; Reignier, Jean; Garot, Denis; Kreitmann, Louis; Baudel, Jean-Luc; Fartoukh, Muriel; Plantefève, Gaëtan; Beurton, Alexandra; Asfar, Pierre; Boyer, Alexandre; Mekontso-Dessap, Armand; Makris, Demosthènes; Vinsonneau, Christophe; Floch, Pierre-Edouard; Weiss, Nicolas; Ceccato, Adrián; Artigas, Antonio; Bouchereau, Mathilde; Duhamel, Alain; Labreuche, Julien; Nseir, Saad

doi:10.1164/rccm.202101-0030oc

Cited by 75 publications

(104 citation statements)

References 34 publications

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“…More recently, Lebreton et al [ 27 ] reported the greater Paris experience during the COVID-19 pandemic, in which 138/302 (46%) patients were alive 90 days after ECMO initiation. Interestingly, patient pre-ECMO characteristics in this cohort were similar to those observed in our series and the other recently reported studies [ 28 , 29 ].…”

Section: Discussionsupporting

confidence: 90%

Implementation of new ECMO centers during the COVID-19 pandemic: experience and results from the Middle East and India

et al. 2021

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Purpose Extracorporeal membrane oxygenation (ECMO) use for severe coronavirus disease 2019 (COVID-19) patients has increased during the course of the pandemic. As uncertainty existed regarding patient’s outcomes, early guidelines recommended against establishing new ECMO centers. We aimed to explore the epidemiology and outcomes of ECMO for COVID-19 related cardiopulmonary failure in five countries in the Middle East and India and to evaluate the results of ECMO in 5 new centers. Methods This is a retrospective, multicenter international, observational study conducted in 19 ECMO centers in five countries in the Middle East and India from March 1, 2020, to September 30, 2020. We included patients with COVID-19 who received ECMO for refractory hypoxemia and severe respiratory acidosis with or without circulatory failure. Data collection included demographic data, ECMO-related specific data, pre-ECMO patient condition, 24 h post-ECMO initiation data, and outcome. The primary outcome was survival to home discharge. Secondary outcomes included mortality during ECMO, survival to decannulation, and outcomes stratified by center type. Results Three hundred and seven COVID-19 patients received ECMO support during the study period, of whom 78 (25%) were treated in the new ECMO centers. The median age was 45 years (interquartile range IQR 37–52), and 81% were men. New center patients were younger, were less frequently male, had received higher PEEP, more frequently inotropes and prone positioning before ECMO and were less frequently retrieved from a peripheral center on ECMO. Survival to home discharge was 45%. In patients treated in new and established centers, survival was 55 and 41% ( p = 0.03), respectively. Multivariable analysis retained only a SOFA score < 12 at ECMO initiation as associated with survival (odds ratio, OR 1.93 (95% CI 1.05–3.58), p = 0.034), but not treatment in a new center (OR 1.65 (95% CI 0.75–3.67)). Conclusions During pandemics, ECMO may provide favorable outcomes in highly selected patients as resources allow. Newly formed ECMO centers with appropriate supervision of regional experts may have satisfactory results. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-021-06451-w.

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Section: Discussionsupporting

confidence: 90%

Implementation of new ECMO centers during the COVID-19 pandemic: experience and results from the Middle East and India

et al. 2021

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“…This re ected concerns of bacterial co-infection, however, its incidence in ICU COVID-19 patients has been reported to be low (8.1-14%). [53][54][55] Additionally, the use of azithromycin in COVID-19, due to immunomodulatory properties, has shown no clinical bene t in several RCTs. [55][56][57][58][59] Therefore, the routine use of antibiotics in COVID-19 patients is not supported by evidence.…”

Section: Discussionmentioning

confidence: 99%

“…[53][54][55] Additionally, the use of azithromycin in COVID-19, due to immunomodulatory properties, has shown no clinical bene t in several RCTs. [55][56][57][58][59] Therefore, the routine use of antibiotics in COVID-19 patients is not supported by evidence. 60 Based on the results from the open label Recovery RCT, corticosteroid administration increased signi cantly during the plateau phase but we did not nd any survival bene t in patients so treated.…”

Section: Discussionmentioning

confidence: 99%

What Changed Between the Peak and the Plateau Periods of the First COVID-19 Pandemic Wave? A Multicentric Portuguese Cohort Study in Intensive Care.

Pereira

Sousa

Cidade

et al. 2021

Preprint

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BackgroundThe COVID-19 pandemic represented a challenge for intensive care units (ICU) with overwhelming demand, heterogenous outcomes and clinical practices. To improve care a profound knowledge on severe COVID-19 patients during different time points is crucial. This data is still scarce. We aimed to analyze and compare COVID-19 patient demographics, clinical management, and outcomes between two periods from the first pandemic wave.MethodsWe performed a multicentric ambispective cohort study including severe COVID-19 patients between March and August 2020 from 16 Portuguese ICUs. A peak and a plateau period were defined, corresponding to weeks 10-16 and 17-34 of the first pandemic wave. All patients had SARS-CoV-2 pneumonia diagnosis and complete hospital follow-up.ResultsWe included 541 adult patients with a median age of 65 [57-74] years and mostly male (71.2%). Severe acute respiratory distress syndrome developed in 63.9% of cases. Overall, 28-day mortality rate was 23.7% with age and SAPSII (both p<0.001) as independent risk factors.Between peak and plateau periods there were no significant differences in age (65 vs. 66, p=0.6), SAPS II (40 vs. 39, p=0.8), PaO2/FiO2 ratio (139 vs. 136, p=0.6), and antibiotic therapy (57.2% vs. 63.8%, p=0.2) at admission, nor in 28-day mortality (24.4% vs. 22.8%, p=0.7). Adjuvant therapy with corticosteroids had no impact on 28-day mortality (26.9% vs. 22.5% without, p=0.4). The peak period included 53.8% of patients and they had less comorbidities (no comorbidities 29% vs. 36%, p=0.01), presented at admission a higher use of vasopressors (81% vs. 63%, p<0.001), invasive mechanical ventilation (58 vs 49%, p<0.001), prone positioning (60% vs 48%, p=0.009), and hydroxychloroquine (80.2% vs. 13.4%; p<0.001) and lopinavir/ritonavir (60.4% vs. 13.4%; p<0.001) prescription, as compared with the plateau period. In the plateau period, there was a greater use of high flow nasal canula (5% vs 16%, p<0.001) on admission, remdesivir (0.5% vs. 19.9%; p<0.001) and corticosteroid (39% vs. 61%, p<0.001) therapy, and a shorter ICU length-of-stay for survivors (12 days vs. 7, p<0.001).ConclusionThere were significant changes in patient comorbidities, therapies and ICU length-of-stay between peak and plateau periods of the first COVID-19 wave with similar 28-day mortality.

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“…This finding may also explain why studies report different outcomes for ECMO in COVID-19, especially patient factors. The first nationwide study, coming from Chile, demonstrated that, during the 1st wave of the pandemic, ECMO was employed in 14.89:100,000 patients with COVID-19 representing 0.42:100,000 population, and 1.2% of COVID-19 intubated patients) [ 42 ]. The 90-day mortality of ECMO supported COVID-19 patients was 38.8%, comparable to that reported for other indications of ECMO.…”

Section: Ecmo Use In Pandemicsmentioning

confidence: 99%

“…Intracerebral hemorrhage was reported as the commonest cause of death in H1N1 influenza patients treated with v-v ECMO [ 11 , 57 ]. Intracerebral hemorrhage occurred in 12–13% of patients with COVID-19 treated with ECMO [ 39 , 42 ], and the incidence was higher than that reported for ECMO for ARDS caused by other viruses [ 58 ]. It is worth mentioning that the EOLIA study was the only one that did not find an increase in intracranial bleeding with ECMO, probably reflecting that experience in ECMO use is associated with safer use of anticoagulation [ 12 ].…”

Section: Complicationsmentioning

confidence: 99%

A rational approach on the use of extracorporeal membrane oxygenation in severe hypoxemia: advanced technology is not a panacea

Akoumianaki

Jonkman

Sklar

et al. 2021

Ann. Intensive Care

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Veno-venous extracorporeal membrane oxygenation (ECMO) is a helpful intervention in patients with severe refractory hypoxemia either because mechanical ventilation cannot ensure adequate oxygenation or because lung protective ventilation is not feasible. Since ECMO is a highly invasive procedure with several, potentially devastating complications and its implementation is complex and expensive, simpler and less invasive therapeutic options should be first exploited. Low tidal volume and driving pressure ventilation, prone position, neuromuscular blocking agents and individualized ventilation based on transpulmonary pressure measurements have been demonstrated to successfully treat the vast majority of mechanically ventilated patients with severe hypoxemia. Veno-venous ECMO has a place in the small portion of severely hypoxemic patients in whom these strategies fail. A combined analysis of recent ARDS trials revealed that ECMO was used in only 2.15% of patients (n = 145/6736). Nevertheless, ECMO use has sharply increased in the last decade, raising questions regarding its thoughtful use. Such a policy could be harmful both for patients as well as for the ECMO technique itself. This narrative review attempts to describe together the practical approaches that can be offered to the sickest patients before going to ECMO, as well as the rationale and the limitations of ECMO. The benefit and the drawbacks associated with ECMO use along with a direct comparison with less invasive therapeutic strategies will be analyzed.

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Early Bacterial Identification among Intubated Patients with COVID-19 or Influenza Pneumonia: A European Multicenter Comparative Clinical Trial

Abstract: Antoine, Maladies métaboliques, biliaires et fibroinflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN).

Cited by 75 publications

References 34 publications

Implementation of new ECMO centers during the COVID-19 pandemic: experience and results from the Middle East and India

Implementation of new ECMO centers during the COVID-19 pandemic: experience and results from the Middle East and India

What Changed Between the Peak and the Plateau Periods of the First COVID-19 Pandemic Wave? A Multicentric Portuguese Cohort Study in Intensive Care.

A rational approach on the use of extracorporeal membrane oxygenation in severe hypoxemia: advanced technology is not a panacea

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