Application of extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome induced by avian influenza A (H7N9) viral pneumonia: national data from the Chinese multicentre collaboration
单位：[1]Department of Pulmonary and Critical Care Medicine, Centre for RespiratoryDiseases, China-Japan Friendship Hospital, No[2]Yinghua East Road,Chaoyang District, Beijing 100029, People’s Republic of China ,The FirstAffiliated Hospital of Nanchang University, Nanchang, Jiangxi Province,People’s Republic of China[3]Department of Critical Care Medicine, ZhongdaHospital, Southeast University, Nanjing, Jiangsu Province, People’s Republic ofChina[4]Department of Intensive Care Unit, Wuhan Medical Treatment CenterHospital, Wuhan, Hubei Province, People’s Republic of China[5]Department ofIntensive Care Unit, The First Affiliated Hospital of Wannan Medical College,Yijishan Hospital, Wuhu, Anhui Province, People’s Republic of China[6]Department of Intensive Care Unit, Taizhou People’s Hospital, Taizhou,Jiangsu Province, People’s Republic of China[7]Department of Intensive CareUnit, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province,People’s Republic of China[8]Department of Intensive Care Unit, SuzhouMunicipal Hospital, Suzhou, Jiangsu Province, People’s Republic of China[9]Department of Infectious Diseases, Henan Provincial People’s Hospital,Zhengzhou, Henan Province, People’s Republic of China[10]Department ofIntensive Care Unit, Dongguan People’s Hospital, Dongguan, GuangdongProvince, People’s Republic of China[11]Department of Intensive Care Unit,The First People’s Hospital of Kunshan, Kunshan, Jiangsu Province, People’sRepublic of China
Background: Evidence concerning the efficacy and safety of extracorporeal membrane oxygenation (ECMO) in patients with influenza A (H7N9) has been was limited to case reports. Our study is aimed to investigate the current application, efficacy and safety of ECMO in for severe H7N9 pneumonia-associated acute respiratory distress syndrome (ARDS) in the Chinese population. Methods: A multicentre retrospective cohort study was conducted at 20 hospitals that admitted patients with avian influenza A (H7N9) viral pneumonia patients' admission from 9 provinces in China between October 1, 2016, and March 1, 2017. Data from the National Health and Family Planning Commission of China, including general conditions, outcomes and ECMO management, were analysed. Then, successfully weaned and unsuccessfully weaned groups were compared. Results: A total of 35 patients, aged 57 +/- 1 years, were analysed; 65.7% of patients were male with 63% mortality. All patients underwent invasive positive pressure ventilation (IPPV), and rescue ventilation strategies were implemented for 23 cases (65.7%) with an average IPPV duration of 5 +/- 1 d, PaO2/FiO(2) of 78 +/- 23 mmHg, tidal volume (VT) of 439 +/- 61 ml and plateau pressure (P-plat) of 29 +/- 8 cmH(2)O pre-ECMO. After 48 h on ECMO, PaO2 improved from 56 +/- 21 mmHg to 90 +/- 24 mmHg and PaCO2 declined from 52 +/- 24 mmHg to 38 +/- 24 mmHg. Haemorrhage, ventilator-associated pneumonia (VAP) and barotrauma occurred in 45.7%, 60% and 8.6% of patients, respectively. Compared with successfully weaned patients (n = 14), the 21 unsuccessfully weaned patients had a longer duration of IPPV pre-ECMO (6 +/- 4 d vs. 2 +/- 1 d, P < 0.01) as well as a higher P-plat (25 +/- 5 cmH(2)O vs. 21 +/- 3 cmH(2)O, P < 0.05) and VT (343 +/- 96 ml vs. 246 +/- 93 ml, P < 0.05) after 48 h on ECMO support. Furthermore, the unsuccessfully weaned group had a higher mortality (100% vs. 7.1%, P < 0.01) with more haemorrhage (77.3% vs. 28.6%, P < 0.01). Conclusions: ECMO is effective at improving oxygenation and ventilation of patients with avian influenza A (H7N9) induced severe ARDS. Early initiation of ECMO with appropriate IPPV settings and anticoagulation strategies are necessary to reduce complications.
基金：
National Key Research and Development Programme-Major Chronic Non-Communicable Diseases' Prevention and Control [QML 2016YFC1304300]; National Science Fund for Distinguished Young ScholarsNational Natural Science Foundation of China (NSFC)National Science Fund for Distinguished Young Scholars [81425001/H0104]; National Natural Science Foundation of ChinaNational Natural Science Foundation of China (NSFC) [81271840/H1904, 81030032/H19]; National Program for the Prevention and Control of Human Infections by Avian-Origin H7N9 Influenza A Virus [KJYJ-2013-01-05]
第一作者单位：[1]Department of Pulmonary and Critical Care Medicine, Centre for RespiratoryDiseases, China-Japan Friendship Hospital, No
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推荐引用方式(GB/T 7714)：
Linna Huang,Wei Zhang,Yi Yang,et al.Application of extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome induced by avian influenza A (H7N9) viral pneumonia: national data from the Chinese multicentre collaboration[J].BMC INFECTIOUS DISEASES.2018,18:doi:10.1186/s12879-017-2903-x.
APA：
Linna Huang,Wei Zhang,Yi Yang,Wenjuan Wu,Weihua Lu...&Chen Wang.(2018).Application of extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome induced by avian influenza A (H7N9) viral pneumonia: national data from the Chinese multicentre collaboration.BMC INFECTIOUS DISEASES,18,
MLA：
Linna Huang,et al."Application of extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome induced by avian influenza A (H7N9) viral pneumonia: national data from the Chinese multicentre collaboration".BMC INFECTIOUS DISEASES 18.(2018)
