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Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus.
Ann Intensive Care. 2018 Jan 10; 8(1):3.AI

Abstract

BACKGROUND

Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS-CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in severely hypoxemic patients who failed conventional strategies.

METHODS

We collected data retrospectively on MERS-CoV patients with refractory respiratory failure from April 2014 to December 2015 in 5 intensive care units (ICUs) in Saudi Arabia. Patients were classified into two groups: ECMO versus conventional therapy. Our primary outcome was in-hospital mortality; secondary outcomes included ICU and hospital length of stay.

RESULTS

Thirty-five patients were included; 17 received ECMO and 18 received conventional therapy. Both groups had similar baseline characteristics. The ECMO group had lower in-hospital mortality (65 vs. 100%, P = 0.02), longer ICU stay (median 25 vs. 8 days, respectively, P < 0.01), and similar hospital stay (median 41 vs. 31 days, P = 0.421). In addition, patients in the ECMO group had better PaO2/FiO2 at days 7 and 14 of admission to the ICU (124 vs. 63, and 138 vs. 36, P < 0.05), and less use of norepinephrine at days 1 and 14 (29 vs. 80%; and 36 vs. 93%, P < 0.05).

CONCLUSIONS

ECMO use, as a rescue therapy, was associated with lower mortality in MERS patients with refractory hypoxemia. The results of this, largest to date, support the use of ECMO as a rescue therapy in patients with severe MERS-CoV.

Authors+Show Affiliations

Department of Emergency and Critical Care, King Fahad Hospital of the University-Dammam University, PO Box 40236, Al Khobar, 31952, Saudi Arabia. msshahrani@uod.edu.sa.Department of Medicine/Intensive Care, King Abdulaziz University, Jeddah, Saudi Arabia.Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE.Medical Director of Critical Care, Dr. Suliman Al-Habib Group, AlFaisal University, Riyadh, Saudi Arabia.Department of Anesthesiology, Dammam University, Dammam, Saudi Arabia.King Abdulaziz University, Jeddah, Saudi Arabia.Department of ICU, King Fahad Hospital, Jeddah, Saudi Arabia.King Abdulaziz University, Jeddah, Saudi Arabia.King Abdulaziz Medical City, NGHA, Jeddah, Saudi Arabia. Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.Department of ICU National Hospital, Internal Medicine and Critical Care, Riyadh, Saudi Arabia.Critical Care Medicine Department, Cairo University Hospitals, Cairo, Egypt.Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.Department of Cardiac Surgery, King Abdullah Medical City, Makkah, Saudi Arabia.Department of Surgery/Intensive Care, King Abdulaziz University, Jeddah, Saudi Arabia.Community Medicine Department, Ministry of Health, Jeddah, Saudi Arabia.Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada.Department of Critical Care, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29330690

Citation

Alshahrani, Mohammed S., et al. "Extracorporeal Membrane Oxygenation for Severe Middle East Respiratory Syndrome Coronavirus." Annals of Intensive Care, vol. 8, no. 1, 2018, p. 3.
Alshahrani MS, Sindi A, Alshamsi F, et al. Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. Annals of intensive care. 2018;8(1):3.
Alshahrani, M. S., Sindi, A., Alshamsi, F., Al-Omari, A., El Tahan, M., Alahmadi, B., Zein, A., Khatani, N., Al-Hameed, F., Alamri, S., Abdelzaher, M., Alghamdi, A., Alfousan, F., Tash, A., Tashkandi, W., Alraddadi, R., Lewis, K., Badawee, M., Arabi, Y. M., ... Alhazzani, W. (2018). Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. Annals of Intensive Care, 8(1), 3. https://doi.org/10.1186/s13613-017-0350-x
Alshahrani MS, et al. Extracorporeal Membrane Oxygenation for Severe Middle East Respiratory Syndrome Coronavirus. Annals of intensive care. 2018 Jan 10;8(1):3. PubMed PMID: 29330690.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. AU - Alshahrani,Mohammed S, AU - Sindi,Anees, AU - Alshamsi,Fayez, AU - Al-Omari,Awad, AU - El Tahan,Mohamed, AU - Alahmadi,Bayan, AU - Zein,Ahmed, AU - Khatani,Naif, AU - Al-Hameed,Fahad, AU - Alamri,Sultan, AU - Abdelzaher,Mohammed, AU - Alghamdi,Amenah, AU - Alfousan,Faisal, AU - Tash,Adel, AU - Tashkandi,Wail, AU - Alraddadi,Rajaa, AU - Lewis,Kim, AU - Badawee,Mohammed, AU - Arabi,Yaseen M, AU - Fan,Eddy, AU - Alhazzani,Waleed, Y1 - 2018/01/10/ PY - 2017/07/09/received PY - 2017/12/29/accepted PY - 2018/1/14/entrez PY - 2018/1/14/pubmed PY - 2018/1/14/medline KW - Coronavirus infection KW - Extracorporeal membrane oxygenation KW - Rescue therapy KW - Signs and symptoms respiratory SP - 3 EP - 3 JF - Annals of intensive care VL - 8 IS - 1 N2 - BACKGROUND: Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS-CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in severely hypoxemic patients who failed conventional strategies. METHODS: We collected data retrospectively on MERS-CoV patients with refractory respiratory failure from April 2014 to December 2015 in 5 intensive care units (ICUs) in Saudi Arabia. Patients were classified into two groups: ECMO versus conventional therapy. Our primary outcome was in-hospital mortality; secondary outcomes included ICU and hospital length of stay. RESULTS: Thirty-five patients were included; 17 received ECMO and 18 received conventional therapy. Both groups had similar baseline characteristics. The ECMO group had lower in-hospital mortality (65 vs. 100%, P = 0.02), longer ICU stay (median 25 vs. 8 days, respectively, P < 0.01), and similar hospital stay (median 41 vs. 31 days, P = 0.421). In addition, patients in the ECMO group had better PaO2/FiO2 at days 7 and 14 of admission to the ICU (124 vs. 63, and 138 vs. 36, P < 0.05), and less use of norepinephrine at days 1 and 14 (29 vs. 80%; and 36 vs. 93%, P < 0.05). CONCLUSIONS: ECMO use, as a rescue therapy, was associated with lower mortality in MERS patients with refractory hypoxemia. The results of this, largest to date, support the use of ECMO as a rescue therapy in patients with severe MERS-CoV. SN - 2110-5820 UR - https://www.unboundmedicine.com/medline/citation/29330690/full_citation L2 - https://dx.doi.org/10.1186/s13613-017-0350-x DB - PRIME DP - Unbound Medicine ER -
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