Abstract
BackgroundMiddle 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.MethodsWe 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.ResultsThirty-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).ConclusionsECMO 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.
Highlights
Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS‐CoV) and is characterized by hypoxemic respiratory failure
We aim to describe the effect of extracorporeal membrane oxygenation (ECMO) rescue therapy on patient-important outcomes in patients with severe MERS-CoV
Baseline characteristics Eighty patients with confirmed MERS-CoV infection were admitted to the intensive care unit (ICU) of participating centers from April 2014 to December 2015
Summary
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. Alshahrani et al Ann. Intensive Care (2018) 8:3 with MERS-CoV who develop acute respiratory distress syndrome (ARDS) are at a high risk of dying from refractory hypoxemia, multiorgan failure, and septic shock [4]. Intensive Care (2018) 8:3 with MERS-CoV who develop acute respiratory distress syndrome (ARDS) are at a high risk of dying from refractory hypoxemia, multiorgan failure, and septic shock [4] Current interventions such as lung protective ventilation, prone ventilation, and neuromuscular blocking agents have been shown in randomized trials to improve mortality in patients with ARDS [5,6,7]. We aim to describe the effect of ECMO rescue therapy on patient-important outcomes in patients with severe MERS-CoV
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