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1. Incidence, clinical characteristics, and outcome after unexpected cardiac arrest among critically ill adults with COVID-19: insight from the multicenter prospective ACICOVID-19 registry

Author

Jonathan Chelly, Gaetan Plantefève, Toufik Kamel, Cédric Bruel, Saad Nseir, Christopher Lai, Giulia Cirillo, Elena Skripkina, Sébastien Ehrminger, Fernando-Daniel Berdaguer-Ferrari, Julien Le Marec, Marine Paul, Aurélie Autret, Nicolas Deye, and the ACICOVID-19 study group

Subjects
In-hospital cardiac arrest, Intensive care unit, SARS-CoV-2, COVID-19, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Initial reports have described the poor outcome of unexpected cardiac arrest (CA) in intensive care unit (ICU) among COVID-19 patients in China and the USA. However, there are scarce data on characteristics and outcomes of such CA patients in Europe. Methods Prospective registry in 35 French ICUs, including all in-ICU CA in COVID-19 adult patients with cardiopulmonary resuscitation (CPR) attempt. Favorable outcome was defined as modified Rankin scale ranging from 0 to 3 at day 90 after CA. Results Among the 2425 COVID-19 patients admitted to ICU from March to June 2020, 186 (8%) experienced in-ICU CA, of whom 146/186 (78%) received CPR. Among these 146 patients, 117 (80%) had sustained return of spontaneous circulation, 102 (70%) died in the ICU, including 48 dying within the first day after CA occurrence and 21 after withdrawal of life-sustaining therapy. Most of CA were non-shockable rhythm (90%). At CA occurrence, 132 patients (90%) were mechanically ventilated, 83 (57%) received vasopressors and 75 (51%) had almost three organ failures. Thirty patients (21%) had a favorable outcome. Sepsis-related organ failure assessment score > 9 before CA occurrence was the single parameter constantly associated with unfavorable outcome in multivariate analysis. Conclusions In-ICU CA incidence remains high among a large multicenter cohort of French critically ill adults with COVID-19. However, 21% of patients with CPR attempt remained alive at 3 months with good functional status. This contrasts with other recent reports showing poor outcome in such patients. Trial registration: This study was retrospectively registered in ClinicalTrials.gov (NTC04373759) in April 2020 ( https://www.clinicaltrials.gov/ct2/show/NCT04373759?term=acicovid&draw=2&rank=1 ).

Published
2021
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2. Contemporary Management of Severe Symptomatic Aortic Stenosis

Author

Marc Eugène, Piotr Duchnowski, Bernard Prendergast, Olaf Wendler, Cécile Laroche, Jean-Luc Monin, Yannick Jobic, Bogdan A. Popescu, Jeroen J. Bax, Alec Vahanian, Bernard Iung, Jeroen Bax, Michele De Bonis, Victoria Delgado, Michael Haude, Gerhard Hindricks, Aldo P. Maggioni, Luc Pierard, Susanna Price, Raphael Rosenhek, Frank Ruschitzka, Stephan Windecker, Souad Mekhaldi, Katell Lemaitre, Sébastien Authier, Magdy Abdelhamid, Astrid Apor, Gani Bajraktari, Branko Beleslin, Alexander Bogachev-Prokophiev, Daniela Cassar Demarco, Agnes Pasquet, Sait Mesut Dogan, Andrejs Erglis, Arturo Evangelista, Artan Goda, Nikolaj Ihlemann, Huseyin Ince, Andreas Katsaros, Katerina Linhartova, Julia Mascherbauer, Erkin Mirrakhimov, Vaida Mizariene, Shelley Rahman-Haley, Regina Ribeiras, Fuad Samadov, Antti Saraste, Iveta Simkova, Elizabeta Srbinovska Kostovska, Lidia Tomkiewicz-Pajak, Christophe Tribouilloy, Eliverta Zera, Mimoza Metalla, Ervina Shirka, Elona Dado, Loreta Bica, Jorida Aleksi, Gerti Knuti, Lidra Gjyli, Rudina Pjeci, Eritinka Shuperka, Erviola Lleshi, Joana Rustemaj, Marsjon Qordja, Mirald Gina, Senada Husi, Daniel Basic, Regina Steringer-Mascherbauer, Charlotte Huber, Christian Ebner, Elisabeth Sigmund, Andrea Ploechl, Thomas Sturmberger, Veronica Eder, Tanja Koppler, Maria Heger, Andreas Kammerlander, Franz Duca, Christina Binder, Matthias Koschutnik, Leonard Perschy, Lisa Puskas, Chen-Yu Ho, Farid Aliyev, Vugar Guluzada, Galib Imanov, Firdovsi Ibrahimov, Abbasali Abbasaliyev, Tahir Ahmedov, Fargana Muslumova, Jamil Babayev, Yasmin Rustamova, Tofig Jahangirov, Rauf Samadov, Muxtar Museyibov, Elnur Isayev, Oktay Musayev, Shahin Xalilov, Saleh Huseynov, Madina Yuzbashova, Vuqar Zamanov, Vusal Mammadov, Gery Van Camp, Martin Penicka, Hedwig Batjoens, Philippe Debonnaire, Daniel Dendooven, Sebastien Knecht, Mattias Duytschaever, Yves Vandekerckhove, Luc Missault, Luc Muyldermans, René Tavernier, Tineke De Grande, Patrick Coussement, Joyce DeTroyer, Katrien Derycker, Kelly De Jaegher, Antoine Bondue, Christophe Beauloye, Céline Goffinet, Daniela Corina Mirica, Frédéric Vanden Eynden, Philippe Van de Borne, Béatrice Van Frachen, David Vancraeynest, Jean Louis Vanoverschelde, Sophie Pierard, Mihaela Malanca, Florence Sinnaeve, Séverine Tahon, Marie De Clippel, Frederic Gayet, Jacques Loiseau, Nico Van de Veire, Veronique Moerman, Anne-Marie Willems, Bernard Cosyns, Steven Droogmans, Andreea Motoc, Dirk Kerkhove, Daniele Plein, Bram Roosens, Caroline Weytjens, Patrizio Lancellotti, Elena Raluca Dulgheru, Ilona Parenicova, Helena Bedanova, Frantisek Tousek, Stepanka Sindelarova, Julia Canadyova, Milos Taborsky, Jiri Ostransky, null Ivona simkova, Marek Vicha, Libor Jelinek, Irena Opavska, Miroslav Homza, Miriam Kvrayola, Radim Brat, Dan Mrozek, Eva Lichnerova, Iveta Docekalova, Marta Zarybnicka, Marketa Peskova, Patrik Roucka, Vlasta Stastna, Dagmar Jungwirtova Vondrackova, Alfred Hornig, Matus Niznansky, Marian Branny, Alexandra Vodzinska, Miloslav Dorda, Libor Snkouril, Krystyna Kluz, Jana Kypusova, Radka Nezvalova, Niels Thue Olsen, Hosam Hasan Ali, Salma Taha, Mohamed Hassan, Ahmed Afifi, Hamza Kabil, Amr Mady, Hany Ebaid, Yasser Ahmed, Mohammad Nour, Islam Talaat, CairoMaiy El Sayed, Ahmad Elsayed Mostafa, CairoYasser Sadek, CairoSherif Eltobgi, Sameh Bakhoum, Ramy Doss, Mahmoud Sheashea, Abd Allah Elasry, Ahmed Fouad, Mahmoud Baraka, Sameh Samir, Alaa Roshdy, Yasmin AbdelRazek, Mostafa M. Abd Rabou, Ahmed Abobakr, Moemen Moaaz, Mohamed Mokhtar, Mohamed Ashry, Khaled Elkhashab, Haytham Soliman Ghareeb, Mostafa Kamal, Gomaa AbdelRazek, GizaNabil Farag, Giza:Ahmed Elbarbary, Evette Wahib, Ghada Kazamel, Diaa Kamal, Mahmoud Tantawy, Adel Alansary, Mohammed Yahia, Raouf Mahmoud, Tamer El Banna, Mohamed Atef, Gamela Nasr, Salah Ahmed, Ehab E. El Hefny, Islam Saifelyazal, Mostafa Abd El Ghany, Abd El Rahman El Hadary, Ahmed Khairy, Jyri Lommi, Mika Laine, Minna Kylmala, Katja Kankanen, Anu Turpeinen, Juha Hartikainen, Lari Kujanen, Juhani Airaksinen, Tuija Vasankari, Catherine Szymanski, Yohann Bohbot, Mesut Gun, Justine Rousseaux, Loic Biere, Victor Mateus, Martin Audonnet, Jérémy Rautureau, Charles Cornet, Emmanuel Sorbets, BourgesKarine Mear, Adi Issa, Florent Le Ven, Marie-Claire Pouliquen, Martine Gilard, Alice Ohanessian, Ali Farhat, Alina Vlase, Fkhar Said, Caroline Lasgi, Carlos Sanchez, Romain Breil, Marc Peignon, Jean-Philippe Elkaim, Virginie Jan-Blin, Sylvain Ropars BertrandM'Ban, Hélène Bardet, Samuel Sawadogo, Aurélie Muschoot, Dieudonné Tchatchoua, Simon Elhadad, Aline Maubert, Tahar Lazizi, Kais Ourghi, Philippe Bonnet, Clarisse Menager-Gangloff, Sofiene Gafsi, Djidjiga Mansouri, Victor Aboyans, Julien Magne, Elie Martins, Sarah Karm, Dania Mohty, Guillaume Briday, Amandine David, Sylvestre Marechaux, Caroline Le Goffic, Camille Binda, Aymeric Menet, Francois Delelis, Anne Ringlé, Anne-Laure Castel, Ludovic Appert, Domitille Tristram, Camille Trouillet, Yasmine Nacer, Lucas Ngoy, MarseilleGilbert Habib, Franck Thuny, Julie Haentjens, Jennifer Cautela, Cécile Lavoute, Floriane Robin, Pauline Armangau, Ugo Vergeylen, Khalil Sanhadji, Nessim Hamed Abdallah, Hassan Kerzazi, Mariana Perianu, François Plurien, Chaker Oueslati, Mathieu Debauchez, Zannis Konstantinos, Alain Berrebi, Alain Dibie, Emmanuel Lansac, Aurélie Veugeois, Christelle Diakov, Christophe Caussin, Daniel Czitrom, Suzanna Salvi, Nicolas Amabile, Patrice Dervanian, Stéphanie Lejeune, Imane Bagdadi, Yemmi Mokrane, Gilles Rouault, Jerome Abalea, Marion Leledy, Patrice Horen, Erwan Donal, Christian Bosseau, Elise Paven, Elena Galli, Edouard Collette, Jean-Marie Urien, Valentin Bridonneau, Renaud Gervais, Fabrice Bauer, Houzefa Chopra, Arthur Charbonnier, David Attias, Nesrine Dahouathi, Moukda Khounlaboud, Magalie Daudin, Christophe Thebault, Cécile Hamon, Philippe Couffon, Catherine Bellot, Maelle Vomscheid, Anne Bernard, Fanny Dion, Djedjiga Naudin, Mohammed Mouzouri, Mathilde Rudelin, Alain Berenfeld, Thibault Vanzwaelmen, Tarik Alloui, Marija Gjerakaroska Radovikj, Slavica Jordanova, Werner Scholtz, Eva Liberda-Knoke, Melanie Wiemer, Andreas Mugge, Georg Nickenig, Jan-Malte Sinning, Alexander Sedaghat, Matthias Heintzen, Jan Ballof, Daniel Frenk, Rainer Hambrecht, Harm Wienbergen, Annemarie Seidel, Rico Osteresch, Kirsten Kramer, Janna Ziemann, Ramona Schulze, Wolfgang Fehske, Clarissa Eifler, Bahram Wafaisade, Andreas Kuhn, Sören Fischer, Lutz Lichtenberg, Mareike Brunold, Judith Simons, Doris Balling, Thomas Buck, Bjoern Plicht, Wolfgang Schols, Henning Ebelt, Marwan Chamieh, Jelena Anacker, Tienush Rassaf, Alexander Janosi, Alexander Lind, Julia Lortz, Peter Lüdike, Philipp Kahlert, Harald Rittger, Gabriele Eichinger, Britta Kuhls, Stephan B. Felix, Kristin Lehnert, Ann-Louise Pedersen, Marcus Dorr, Klaus Empen, Sabine Kaczmarek, Mathias Busch, Mohammed Baly, Fikret Er, Erkan Duman, Linda Gabriel, Christof Weinbrenner, Johann Bauersachs, Julian Wider, Tibor Kempf, Michael Bohm, Paul-Christian Schulze, C. Tudor Poerner, Sven Möbius-Winkler, Karsten Lenk, Kerstin Heitkamp, Marcus Franz, Sabine Krauspe, Burghard Schumacher, Volker Windmuller, Sarah Kurwitz, Holger Thiele, Thomas Kurz, Roza Meyer-Saraei, Ibrahim Akin, Christian Fastner, Dirk Lossnitzer, Ursula Hoffmann, Martin Borggrefe, Stefan Baumann, Brigitte Kircher, Claudia Foellinger, Heike Dietz, Bernhard Schieffer, Feraydoon Niroomand, Harald Mudra, Lars Maier, Daniele Camboni, Christoph Birner, Kurt Debl, Michael Paulus, Benedikt Seither, Nour Eddine El Mokhtari, Alper Oner, Evren Caglayan, Mohammed Sherif, Seyrani Yucel, Florian Custodis, Robert Schwinger, Marc Vorpahl, Melchior Seyfarth, Ina Nover, Till Koehler, Sarah Christiani, David Calvo Sanchez, Barbel Schanze, Holger Sigusch, Athir Salman, Jane Hancock, John Chambers, Camelia Demetrescue, Claire Prendergast, Miles Dalby, Robert Smith, Paula Rogers, Cheryl Riley, Dimitris Tousoulis, Ioannis Kanakakis, Konstantinos Spargias, Konstantinos Lampropoulos, Tolis Panagiotis, Athanasios Koutsoukis, Lampros Michalis, Ioannis Goudevenos, Vasileios Bellos, Michail Papafaklis, Lampros Lakkas, George Hahalis, Athanasios Makris, Haralampos Karvounis, Vasileios Kamperidis, Vlasis Ninios, Vasileios Sachpekidis, Pavlos Rouskas, Leonidas Poulimenos, Georgios Charalampidis, Eftihia Hamodraka, Athanasios Manolis, Robert Gabor Kiss, Tunde Borsanyi, Zoltan Jarai, Andras Zsary, Elektra Bartha, Annamaria Kosztin, Alexandra Doronina, Attila Kovacs, Barabas Janos Imre, Chun Chao, Kalman Benke, Istvan Karoczkai, Kati Keltai, Zsolt Förchécz, Zoltán Pozsonyi, Zsigmond Jenei, Adam Patthy, Laszlo Sallai, Zsuzsanna Majoros, Tamás Pál, Jusztina Bencze, Ildiko Sagi, Andrea Molnar, Anita Kurczina, Gabor Kolodzey, Istvan Edes, Valeria Szatmari, Zsuzsanna Zajacz, Attila Cziraki, Adam Nemeth, Reka Faludi, Laszlone Vegh, Eva Jebelovszki, Geza Karoly Lupkovics, Zsofia Kovacs, Andras Horvath, Gezim Berisha, Pranvera Ibrahimi, Luan Percuku, Rano Arapova, Elmira Laahunova, Kseniia Neronova, Zarema Zhakypova, Gulira Naizabekova, Gulnazik Muratova, Iveta Sime, Nikolajs Sorokins, Ginta Kamzola, Irina Cgojeva-Sproge, Gita Rancane, Ramune Valentinaviciene, Laima Rudiene, Rasa Raugaliene, Aiste Bardzilauske, Regina Jonkaitiene, Jurate Petrauskaite, Monika Bieseviciene, Raimonda Verseckaite, Ruta Zvirblyte, Danute Kalibatiene, Greta Radauskaite, Gabija Janaviciute-Matuzeviciene, Dovile Jancauskaite, Deimile Balkute, Juste Maneikyte, Ingrida Mileryte, Monika Vaisvilaite, Lina Gedvilaite, Mykolas Biliukas, Vaiva Karpaviciene, Robert George Xuereb, Elton Pllaha, Roxana Djaberi, Klaudiusz Komor, Agnieszka Gorgon-Komor, Beata Loranc, Jaroslaw Myszor, Katarzyna Mizia-Stec, Adrianna Berger-Kucza, Magdalena Mizia, Mateusz Polak, Piotr Bogacki, Piotr Podolec, Monika Komar, Ewa Sedziwy, Dorota Sliwiak, Bartosz Sobien, Beata Rog, Marta Hlawaty, Urszula Gancarczyk, Natasza Libiszewska, Danuta Sorysz, Andrzej Gackowski, Malgorzata Cieply, Agnieszka Misiuda, Franciszek Racibor, Anna Nytko, Kazimierz Widenka, Maciej Kolowca, Janusz Bak, Andrzej Curzytek, Mateusz Regulski, Malgorzata Kamela, Mateusz Wisniowski, Tomasz Hryniewiecki, Piotr Szymanski, Monika Rozewicz, Maciej Grabowski, Andrzej Budaj, Beata Zaborska, Ewa Pilichowska-Paskiet, Malgorzata Sikora-Frac, Tomasz Slomski, Isabel Joao, Ines Cruz, Hélder Pereira, Rita Cale, Ana Marques, Ana Rita Pereira, Carlos Morais, Antonio Freitas, David Roque, Nuno Antunes, Antonio Costeira Pereira, Catarina Vieira, Nuno Salome, Juliana Martins, Isabel Campos, Goncalo Cardoso, Claudia Silva, Afonso Oliveira, Mariana Goncalves, Rui Martins, Nuno Quintal, Bruno Mendes, Joseline Silva, Joao Ferreira, James Milner, Patricia Alves, Vera Marinho, Paula Gago, Jose Amado, Joao Bispo, Dina Bento, Inocencia Machado, Margarida Oliveira, Lucy Calvo, Pedro von Hate, Bebiana Faria, Ana Galrinho, Luisa Branco, Antonio Goncalves, Tiago Mendonca, Mafalda Selas, Filipe Macedo, Carla Sousa, Sofia Cabral, Filomena Oliveira, Maria Trepa, Marta Fontes-Oliveira, Alzira Nunes, Paulo Araújo, Vasco Gama Ribeiro, Joao Almeida, Alberto Rodrigues, Pedro Braga, Sonia Dias, Sofia Carvalho, Catarina Ferreira, Alberto Ferreira, Pedro Mateus, Miguel Moz, Silvia Leao, Renato Margato, Ilidio Moreira, Jose Guimanaes, Joana Ribeiro, Fernando Goncalves, Jose Cabral, Ines Almeida, Luisa Goncalves, Mariana Tarusi, Calin Pop, Claudia Matei, Diana Tint, Sanziana Barbulescu, Sorin Micu, Ioana Pop, Costica Baba, Doina Dimulescu, Maria Dorobantu, Carmen Ginghina, Roxana Onut, Andreea Popescu, Brandusa Zamfirescu, Raluca Aflorii, Mihaela Popescu, Liviu Ghilencea, Andreeea Rachieru, Monica Stoian, Nicoleta Oprescu, Silvia Iancovici, Iona Petre, Anca Doina Mateescu, Andreea Calin, Simona Botezatu, Roxana Enache, Monica Rosca, Daniela Ciuperca, Evelyn Babalac, Ruxandra Beyer, Laura Cadis, Raluca Rancea, Raluca Tomoaia, Adela Rosianu, Emese Kovacs, Constantin Militaru, Alina Craciun, Oana Mirea, Mihaela Florescu, Lucica Grigorica, Daniela Dragusin, Luiza Nechita, Mihai Marinescu, Teodor Chiscaneanu, Lucia Botezatu, Costela Corciova, Antoniu Octavian Petris, Catalina Arsenescu-Georgescu, Delia Salaru, Dan Mihai Alexandrescu, Carmjen Plesoianu, Ana Tanasa, Ovidiu Mitu, Irina Iuliana Costache, Ionut Tudorancea, Catalin Usurelu, Gabriela Eminovici, Ioan Manitiu, Oana Stoia, Adriana Mitre, Dan-Octavian Nistor, Anca Maier, Silvia Lupu, Mihaela Opris, Adina Ionac, Irina Popescu, Simina Crisan, Cristian Mornos, Flavia Goanta, Liana Gruescu, Oana Voinescu, Madalina Petcu, Ramona Cozlac, Elena Damrina, Liliya Khilova, Irina Ryazantseva, Dmitry Kozmin, Maria Kiseleva, Marina Goncharova, Kamila Kitalaeva, Victoria Demetskay, Artem Verevetinov, Mikhail Fomenko, Elena Skripkina, Viktor Tsoi, Georgii Antipov, Yuri Schneider, Denis Yazikov, Marina Makarova, Aleksei Cherkes, Natalya Ermakova, Aleksandr Medvedev, Anastasia Sarosek, Mikhail Isayan, Tatyana Voronova, Oleg Kulumbegov, Alina Tuchina, Sergei Stefanov, Margarita Klimova, Konstantin Smolyaninov, Zhargalma Dandarova, Victoriya Magamet, Natalia Spiropulos, Sergey Boldyrev, Kirill Barbukhatty, Dmitrii Buyankov, Vladimir Yurin, Yuriy Gross, Maksim Boronin, Mariya Mikhaleva, Mariya Shablovskaya, Alex Zotov, Daniil Borisov, Vasily Tereshchenko, Ekaterina Zubova, A. Kuzmin, Ivan Tarasenko, Alishir Gamzaev, Natalya Borovkova, Tatyana Koroleva, Svetlana Botova, Ilya Pochinka, Vera Dunaeva, Victoria Teplitskaya, Elena I. Semenova, Olga V. Korabel'Nikova, Denis S. Simonov, Elena Denisenko, Natalia Harina, Natalia Yarohno, Svetlana Alekseeva, Julia Abydenkova, Lyubov Shabalkina, Olga Mayorova, Valeriy Tsechanovich, Igor Medvedev, Michail Lepilin, PenzaEvgenii Nemchenko, Vadim Karnahin, Vasilya Safina, Yaroslav Slastin, Venera Gilfanova, Roman Gorbunov, Ramis Jakubov, Aigul Fazylova, Mansur Poteev, Laysan Vazetdinova, Indira Tarasova, Rishat Irgaliyev, Olga Moiseeva, Mikhail Gordeev, Olga Irtyuga, Raisa Moiseeva, Nina Ostanina, Dmitry Zverev, Patimat Murtazalieva, Dmitry Kuznetsov, Mariya Skurativa, Larisa Polyaeva, Kirill Mihaiilov, Biljana Obrenovic-Kircanski, Svetozar Putnik, Dragan Simic, Milan Petrovic, Natasa Markovic Nikolic, Ljiljana Jovovic, Dimitra Kalimanovska Ostric, Milan Brajovic, Milica Dekleva Manojlovic, Vladimir Novakovic, Danijela Zamaklar-Trifunovic, Bojana Orbovic, Olga Petrovic, Marija Boricic-Kostic, Kristina Andjelkovic, Marko Milanov, Maja Despotovic-Nikolic, Sreten Budisavljevic, Sanja Veljkovic, Nataša Cvetinovic, Daniijela Lepojevic, Aleksandra Todorovic, Aleksandra Nikolic, Branislava Borzanovic, Ljiljana Trkulja, Slobodan Tomic, Milan Vukovic, Jelica Milosavljevic, Mirjana Milanovic, Vladan Stakic, Aleksandra Cvetkovic, Suzana Milutinovic, Olivera Bozic, Miodrag Miladinovic, Zoran Nikolic, Dinka Despotovic, Dimitrije Jovanovic, Anastazija Stojsic-Milosavljevic, Aleksandra Ilic, Mirjana Sladojevic, Stamenko Susak, Srdjan Maletin, Salvo Pavlovic, Vladimir Kuzmanovic, Nikola Ivanovic, Jovana Dejanovic, Dusan Ruzicic, Dragana Drajic, Danijel Cvetanovic, Marija Mirkovic, Jon Omoran, Roman Margoczy, Katarina Sedminova, Adriana Reptova, Eva Baranova, Tatiana Valkovicova, Gabriel Valocik, Marian Kurecko, Marianna Vachalcova, Alzbeta Kollarova, Martin Studencan, Daniel Alusik, Marek Kozlej, Jana Macakova, Sergio Moral, Merce Cladellas, Daniele Luiso, Alicia Calvo, Jordi Palet, Juli Carballo, Gisela Teixido Tura, Giuliana Maldonado, Laura Gutierrez, Teresa Gonzalez-Alujas, Rodriguez Palomares Jose Fernando, Nicolas Villalva, Ma Jose Molina-Mora, Ramon Rubio Paton, Juan Jose Martinez Diaz, Pablo Ramos Ruiz, Alfonso Valle, Ana Rodriguez, Edgardo Alania, Emilio Galcera, Julia Seller, Gonzalo de la Morena Valenzuela, Daniel Saura Espin, Dolores Espinosa Garcia, Maria Jose Oliva Sandoval, Josefa Gonzalez, Miguel Garcia Navarro, Maria Teresa Perez-Martinez, Jose Ramon Ortega Trujillo, Irene Menduina Gallego, Daniel San Roman, Eliu David Perez Nogales, Olga Medina, Rodolfo Antonio Montiel Quintero, Pablo Felipe Bujanda Morun, Marta Lopez Perez, Jimmy Plasencia Huaripata, Juan Jose Morales Gonzalez, Veronica Quevedo Nelson, Jose Luis Zamorano, Ariana Gonzalez Gomez, Alfonso Fraile, Maria Teresa Alberca, Joaquin Alonso Martin, Covadonga Fernandez-Golfin, Javier Ramos, Sergio Hernandez Jimenez, Cristina Mitroi, Pedro L. Sanchez Fernandez, Elena Diaz-Pelaez, Beatriz Garde, Luis Caballero, Fermin Martinez Garcia, Francisco Cambronero, Noelia Castro, Antonio Castro, Alejandro De La Rosa, Pastora Gallego, Irene Mendez, David Villagomez Villegas, Manuel Gonzalez Correa, Roman Calvo, Francisco Florian, Rafael Paya, Esther Esteban, Francisco Buendia, Andrés Cubillos, Carmen Fernandez, Juan Pablo Cárdenas, José Leandro Pérez-Boscá, Joan Vano, Joaquina Belchi, Cristina Iglesia-Carreno, Francisco Calvo Iglesias, Aida Escudero-Gonzalez, Sergio Zapateria-Lucea, Juan Sterling Duarte, Lara Perez-Davila, Rafael Cobas-Paz, Rosario Besada-Montenegro, Maribel Fontao-Romeo, Elena Lopez-Rodriguez, Emilio Paredes-Galan, Berenice Caneiro-Queija, Alba Guitian Gonzalez, Abdi Bozkurt, Serafettin Demir, Durmus Unlu, Caglar Emre Cagliyan, Muslum Firat Ikikardes, Mustafa Tangalay, Osman Kuloglu, Necla Ozer, Ugur Canpolat, Melek Didem Kemaloglu, Abdullah Orhan Demirtas, Didar Elif Akgün, Eyup Avci, Gokay Taylan, Mustafa Adem Yilmaztepe, Fatih Mehmet Ucar, Servet Altay, Muhammet Gurdogan, Naile Eris Gudul, Mujdat Aktas, Mutlu Buyuklu, Husnu Degirmenci, Mehmet Salih Turan, Kadir Ugur Mert, Gurbet Ozge Mert, Muhammet Dural, Sukru Arslan, Nurten Sayar, Batur Kanar, Beste Ozben Sadic, Ahmet Anil Sahin, Ahmet Buyuk, Onur Kilicarslan, Cem Bostan, Tarik Yildirim, Seda Elcim Yildirim, Kahraman Cosansu, Perihan Varim, Ersin Ilguz, Recep Demirbag, Asuman Yesilay, Abdullah Cirit, Eyyup Tusun, Emre Erkus, Muhammet Rasit Sayin, Zeynep Kazaz, Selim Kul, Turgut Karabag, Belma Kalayci, Clinical sciences, Cardio-vascular diseases, and Cardiology

Subjects
Male, medicine.medical_specialty, Multivariate analysis, Clinical Decision-Making, Risk Assessment, Severity of Illness Index, decision making, surgery, Risk Factors, Internal medicine, Intervention (counseling), medicine, Clinical endpoint, Humans, 03.02. Klinikai orvostan, guidelines, Symptomatic aortic stenosis, Aged, Retrospective Studies, Aged, 80 and over, business.industry, valvular heart disease, Disease Management, aortic stenosis, Aortic Valve Stenosis, Odds ratio, medicine.disease, Europe, Stenosis, Treatment Outcome, Echocardiography, Aortic Valve, Charlson comorbidity index, transcatheter aortic valve replacement, Female, Morbidity, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies, surgical aortic valve replacement
Abstract

BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians. (J Am Coll Cardiol 2021;78:2131-2143) (c) 2021 by the American College of Cardiology Foundation.

Published
2021

3. Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study

Author

Guillaume Lebreton, Matthieu Schmidt, Maharajah Ponnaiah, Thierry Folliguet, Marylou Para, Julien Guihaire, Emmanuel Lansac, Edouard Sage, Bernard Cholley, Bruno Mégarbane, Pierrick Cronier, Jonathan Zarka, Daniel Da Silva, Sebastien Besset, Tristan Morichau-Beauchant, Igor Lacombat, Nicolas Mongardon, Christian Richard, Jacques Duranteau, Charles Cerf, Gabriel Saiydoun, Romain Sonneville, Jean-Daniel Chiche, Patrick Nataf, Dan Longrois, Alain Combes, Pascal Leprince, Charles JUVIN, Thibault SCHOELL, Cosimo D'Alessandro, Sofica MARIN, Nathalie NARDONE, Pierre DEMONDION, Horacio MEYER, Karl BOUNADER, Alexander MOIROUX, Ali AKAMKAM, Guillaume FADEL, Erwan RANDRIANALISOA, Sébastien CUSQUEL, Patrice LE GLOAHEC, Elisabeth HIRSCHAUER, Fabrice MUSQUET, Pierre-Marie Jego, Hélène Guedes, Théophile Roy, Lina Mercereau, Emmanuel Corvol, Anne Laboure, Flore Vilanove, Marco Peperoni, Dariène Machado, Aly Sely, Marion Fortanier, Séverine Gantois, Emilie Tran, Elisabeth Bosq, Aurélie Fontanier, Alice Morin, Jocelyne Cousin, Stéphanie Bovagnet, Charles Edouard Luyt, Guillaume Hekimian, Nicolas Brechot, Marc Pineton de Chambrun, Cyrielle Desnos, Juliette Chomeloux, Jeremy Arzoine, Emmanuelle Guerin, Antoine Monsel, Guillaume Voiriot, David Levy, Elodie Baron, Alexandra Beurton, Juliette Chommeloux, Meng Paris, Safaa Nemlaghi, Pierre Bay, Alexandre Demoule, Bertrand Guidet, Jean Michel Constantin, Muriel Fartoukh, Martin Dres, Guillaume Franchineau, Lucie Le Fevre, Richard Raffoul, Soleiman Alkhoder, Walid Ghodbane, Angelo Pisani, Wael Braham, Ali Bessem Gara, Pierre MORDANT, Yves-Hervé CASTIER, Etienne de MONTMOLLIN, Lila BOUADMA, Jean-François TIMSIT, Olivier Langeron, Quentin de Roux, Claire Alessandri, Margot Arminot-Frémaux, Simon Clariot, Thomas Dessalle, Agathe Kudela, André Ly, Arnaud Meffert, Elena Skripkina, Antonio Fiore, Costin Radu, Eleonora Dupuy-Montbrun, Christian Latremouille, Olaf Mercier, Philippe Deleuze, François STEPHAN, Marie Werner, Jean-Louis Teboul, Xavier Monnet, Hassan Debbagh, Alain Chapelier, Julien De Wolf, Matthieu Glorion, Ciprian Pricopi, Francesco Cassiano, Sébastien Jacquemin, Guillaume Tachon, François Parquin, Benjamin Zuber, Alain Carriou, Jean-Paul Mira, Julien Charpentier, Frederic Pene, Lee Nguyen, Sébastian Voicu, Nicolas Deye, Isabelle Malissin, Laetitia Sutterlin, Giulia Naim, Adrien Pépin-Lehalleur, Aymen Mrad, Jean-Michel Ekhérian, Philippe Nguyen, Georgios Sidéris, Dominique Vodovar, Caroline Grant, Mattéo Arcelli, Alban Copie, Zaccaria Errabih, Antoine Gonde, Adèle Magalhaes, Edouard Meurisse, Kiyoko Nitenberg, Arthur Perault, Lucile Perrin, Maxime Renaux, Sophie Marqué, Luis Ensenyat-Martin, Eric Delpierre, Matthieu Duprey, Daniel da Silva, Bruno Verdière, Julien Amour, Marina Clément, Yves Ollivier, Fabrice Daviaud, Camille Le Breton, Santiago Freita-Ramos, Marc Amouretti, Pierre Antoine Billiet, Myriam Dao, Louis Marie Dumont, Laura Federici, Baptiste Gaborieau, Pierre Postel-Vinay, Constance Vuillard, Noémie Zucman, Didier Dreyfuss, Jean Damien Ricard, Damien Roux, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases [IHU ICAN], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Marie-Lannelongue, Institut Mutualiste de Montsouris (IMM), Hôpital Foch [Suresnes], Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S_1144 / U1144)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Centre Hospitalier Sud Francilien, Centre hospitalier est francilien, Hôpital Delafontaine, Centre Hospitalier de Saint-Denis [Ile-de-France], Hôpital Louis Mourier - AP-HP [Colombes], Centre cardiologique du Nord (CCN), Hôpital Privé Jacques Cartier [Massy], AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Hôpital Cochin [AP-HP], Paris ECMO-COVID-19 investigators, Mégarbane, Bruno, and Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN)

Subjects
Male, ARDS, medicine.medical_treatment, Corrections, [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Cohort Studies, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Fraction of inspired oxygen, score, support: volume, Renal Insufficiency, 030212 general & internal medicine, [SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases, Respiratory Distress Syndrome, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, ecmo covid-19, Articles, Middle Aged, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Pulmonary embolism, [SDV.TOX] Life Sciences [q-bio]/Toxicology, Intensive Care Units, Outcome and Process Assessment, Health Care, surgical procedures, operative, [SDV.TOX]Life Sciences [q-bio]/Toxicology, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Female, France, Cohort study, Pulmonary and Respiratory Medicine, medicine.medical_specialty, 03 medical and health sciences, Extracorporeal Membrane Oxygenation, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Intensive care, medicine, Extracorporeal membrane oxygenation, Humans, Renal replacement therapy, SARS-CoV-2, Septic shock, business.industry, COVID-19, medicine.disease, Survival Analysis, 030228 respiratory system, Emergency medicine, [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract, Pulmonary Embolism, business
Abstract

Erratum inCorrection to Lancet Respir Med 2021; published online April 19. https://doi.org/10.1016/S2213-2600(21)00096-5.; International audience; Background: In the Île-de-France region (henceforth termed Greater Paris), extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) was considered early in the COVID-19 pandemic. We report ECMO network organisation and outcomes during the first wave of the pandemic.Methods: In this multicentre cohort study, we present an analysis of all adult patients with laboratory-confirmed SARS-CoV-2 infection and severe ARDS requiring ECMO who were admitted to 17 Greater Paris intensive care units between March 8 and June 3, 2020. Central regulation for ECMO indications and pooling of resources were organised for the Greater Paris intensive care units, with six mobile ECMO teams available for the region. Details of complications (including ECMO-related complications, renal replacement therapy, and pulmonary embolism), clinical outcomes, survival status at 90 days after ECMO initiation, and causes of death are reported. Multivariable analysis was used to identify pre-ECMO variables independently associated with 90-day survival after ECMO.Findings: The 302 patients included who underwent ECMO had a median age of 52 years (IQR 45-58) and Simplified Acute Physiology Score-II of 40 (31-56), and 235 (78%) of whom were men. 165 (55%) were transferred after cannulation by a mobile ECMO team. Before ECMO, 285 (94%) patients were prone positioned, median driving pressure was 18 cm H2O (14-21), and median ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen was 61 mm Hg (IQR 54-70). During ECMO, 115 (43%) of 270 patients had a major bleeding event, 27 of whom had intracranial haemorrhage; 130 (43%) of 301 patients received renal replacement therapy; and 53 (18%) of 294 had a pulmonary embolism. 138 (46%) patients were alive 90 days after ECMO. The most common causes of death were multiorgan failure (53 [18%] patients) and septic shock (47 [16%] patients). Shorter time between intubation and ECMO (odds ratio 0·91 [95% CI 0·84-0·99] per day decrease), younger age (2·89 [1·41-5·93] for ≤48 years and 2·01 [1·01-3·99] for 49-56 years vs ≥57 years), lower pre-ECMO renal component of the Sequential Organ Failure Assessment score (0·67, 0·55-0·83 per point increase), and treatment in centres managing at least 30 venovenous ECMO cases annually (2·98 [1·46-6·04]) were independently associated with improved 90-day survival. There was no significant difference in survival between patients who had mobile and on-site ECMO initiation.Interpretation: Beyond associations with similar factors to those reported on ECMO for non-COVID-19 ARDS, 90-day survival among ECMO-assisted patients with COVID-19 was strongly associated with a centre's experience in venovenous ECMO during the previous year. Early ECMO management in centres with a high venovenous ECMO case volume should be advocated, by applying centralisation and regulation of ECMO indications, which should also help to prevent a shortage of resources.

Published
2021

4. Rescue fibrinolysis in suspected massive pulmonary embolism during SARS-CoV-2 pandemic

Author

Simon Clariot, Elena Skripkina, Olivier Langeron, Quentin de Roux, Arnaud Meffert, Nicolas Mongardon, Claire Alessandri, and André Ly

Subjects
2019-20 coronavirus outbreak, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), medicine.medical_treatment, Pneumonia, Viral, Emergency Nursing, Article, Betacoronavirus, Fibrinolytic Agents, Pandemic, Fibrinolysis, medicine, Humans, Pandemics, biology, business.industry, SARS-CoV-2, COVID-19, medicine.disease, biology.organism_classification, Virology, Pulmonary embolism, Severe acute respiratory syndrome-related coronavirus, Emergency, Emergency Medicine, business, Coronavirus Infections, Pulmonary Embolism, Cardiology and Cardiovascular Medicine, Fibrinolytic agent
Published
2020

6. Stardust lung and liver after gastric variceal haemorrhage

Author

Jean-Claude Merle, Elena Skripkina, Olivier Langeron, Julie Assaraf, Nicolas Mongardon, Claire Alessandri, Arnaud Meffert, André Ly, and Manuel Vitellius

Subjects
medicine.medical_specialty, Lung, business.industry, General Medicine, Esophageal and Gastric Varices, Critical Care and Intensive Care Medicine, Gastroenterology, Anesthesiology and Pain Medicine, medicine.anatomical_structure, Internal medicine, medicine, Humans, Gastrointestinal Hemorrhage, business
Published
2021

7. Impact of Prone Position in COVID-19 Patients on Extracorporeal Membrane Oxygenation*

Author

Massart, Nicolas, Guervilly, Christophe, Mansour, Alexandre, Porto, Alizée, Flécher, Erwan, Esvan, Maxime, Fougerou, Claire, Fillâtre, Pierre, Duburcq, Thibault, Lebreton, Guillaume, Para, Marylou, Stephan, François, Hraiech, Sami, Ross, James, Schmidt, Matthieu, Vincentelli, André, Nesseler, Nicolas, CHU Pontchaillou [Rennes], Hôpital Yves LE FOLL [Saint-Brieuc], Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), Hôpital Nord [CHU - APHM], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital de la Timone [CHU - APHM] (TIMONE), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Lille, Université de Lille, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Marie-Lannelongue, University of California [Davis] (UC Davis), University of California (UC), Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Extracorporeal Membrane Oxygenation for Respiratory Failure and/or Heart failure related to Severe Acute Respiratory Syndrome Coronavirus 2 (ECMOSARS) Investigators: Olivier Fouquet, Marc Pierrot, Sidney Chocron, Guillaume Flicoteaux, Philippe Mauriat, Hadrien Roze, Alexandre Ouattara, Olivier Huet, Marc-Olivier Fischer, Claire Alessandri, Raphel Bellaïche, Ophélie Constant, Quentin De Roux, André Ly, Arnaud Meffert, Jean-Claude Merle, Lucile Picard, Elena Skripkina, Thierry Folliguet, Nicolas Mongardon, Antonio Fiore, Nicolas D'ostrevy, Marie-Catherine Morgan, Maxime Nguyen, Pierre-Grégoire Guinot, Lucie Gaide-Chevronnay, Nicolas Terzi, Gwenhaël Colin, Olivier Fabre, Arash Astaneh, Justin Issard, Elie Fadel, Dominique Fabre, Antoine Girault, Iolande Ion, Jean Baptiste Menager, Delphine Mitilian, Julien Guihaire, Olaf Mercier, Jacques Thes, Jerôme Jouan, Thibault Duburcq, Valentin Loobuyck, Sabrina Manganiello, Mouhammed Moussa, Agnes Mugnier, Natacha Rousse, Olivier Desebbe, Roland Henaine, Matteo Pozzi, Jean-Luc Fellahi, Jean-Christophe Richard, Zakaria Riad, Laurent Papazian, Matthias Castanier, Charles Chanavaz, Cyril Cadoz, Sebastien Gette, Guillaume Louis, Erick Portocarrero, Philippe Gaudard, Kais Brini, Nicolas Bischoff, Antoine Kimmoun, Bruno Levy, Mathieu Mattei, Pierre Perez, Alexandre Bourdiol, Yannick Hourmant, Pierre-Joachim Mahé, Bertrand Rozec, Mickaël Vourc'h, Stéphane Aubert, Florian Bazalgette, Claire Roger, Sophie Provenchere, Pierre Jaquet, Brice Lortat-Jacob, Pierre Mordant, Patrick Nataf, Juliette Patrier, Morgan Roué, Romain Sonneville, Alexy Tran-Dinh, Paul-Henri Wicky, Charles Al Zreibi, Bernard Cholley, Yannis Guyonvarch, Sophie Hamada, Claudio Barbanti, Anatole Harrois, Astrid Bertier, Jordi Matiello, Thomas Kerforne, Corentin Lacroix, Nicolas Brechot, Juliette Chommeloux, Alain Combes, Jean Michel Constantin, Cosimo D'alessandro, Pierre Demondion, Alexandre Demoule, Martin Dres, Muriel Fartoukh, Guillaume Hekimian, Charles Juvin, Pascal Leprince, Guillaume Fadel, David Levy, Charles Edouard Luyt, Marc Pineton de Chambrun, Thibaut Schoell, Roxane Nicolas, Maud Jonas, Charles Vidal, Nicolas Allou, Salvatore Muccio, Dario Di Perna, Bruno Mourvillier, Vito-Giovanni Ruggieri, Amedeo Anselmi, Karl Bounader, Yoann Launey, Thomas Lebouvier, Alessandro Parasido, Florian Reizine, Philippe Seguin, Emmanuel Besnier, Dorothée Carpentier, Thomas Clavier, Anne Olland, Pierre-Emmanuel Falcoz, Marion Villard, Fanny Bounes, François Labaste, Vincent Minville, Antoine Guillon, Yannick Fedun, and MORNET, Dominique

Subjects
[SDV] Life Sciences [q-bio], critical care, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV]Life Sciences [q-bio], prone position, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, acute respiratory distress syndrome, extracorporeal membrane oxygenation, mechanical ventilation, Critical Care and Intensive Care Medicine, mortality
Abstract

International audience; Objectives: Prone positioning and venovenous extracorporeal membrane oxygenation (ECMO) are both useful interventions in acute respiratory distress syndrome (ARDS). Combining the two therapies is feasible and safe, but the effectiveness is not known. Our objective was to evaluate the potential survival benefit of prone positioning in venovenous ECMO patients cannulated for COVID-19-related ARDS.Design: Retrospective analysis of a multicenter cohort.Patients: Patients on venovenous ECMO who tested positive for severe acute respiratory syndrome coronavirus 2 by reverse transcriptase polymerase chain reaction or with a diagnosis on chest CT were eligible.Interventions: None.Measurements and main results: All patients on venovenous ECMO for respiratory failure in whom prone position status while on ECMO and in-hospital mortality were known were included. Of 647 patients in 41 centers, 517 were included. Median age was 55 (47-61), 78% were male and 95% were proned before cannulation. After cannulation, 364 patients (70%) were proned and 153 (30%) remained in the supine position for the whole ECMO run. There were 194 (53%) and 92 (60%) deaths in the prone and the supine groups, respectively. Prone position on ECMO was independently associated with lower in-hospital mortality (odds ratio = 0.49 [0.29-0.84]; p = 0.010). In 153 propensity score-matched pairs, mortality rate was 49.7% in the prone position group versus 60.1% in the supine position group (p = 0.085). Considering only patients alive at decannulation, propensity-matched proned patients had a significantly lower mortality rate (22.4% vs 37.8%; p = 0.029) than nonproned patients.Conclusions: Prone position may be beneficial in patients supported by venovenous ECMO for COVID-19-related ARDS but more data are needed to draw definitive conclusions.

Published
2022

8. Extracorporeal Membrane Oxygenation for Respiratory Failure Related to COVID-19: A Nationwide Cohort Study

Author

Nicolas, Nesseler, Guillaume, Fadel, Alexandre, Mansour, Marylou, Para, Pierre-Emmanuel, Falcoz, Nicolas, Mongardon, Alizée, Porto, Astrid, Bertier, Bruno, Levy, Cyril, Cadoz, Pierre-Grégoire, Guinot, Olivier, Fouquet, Jean-Luc, Fellahi, Alexandre, Ouattara, Julien, Guihaire, Vito-Giovanni, Ruggieri, Philippe, Gaudard, François, Labaste, Thomas, Clavier, Kais, Brini, Nicolas, Allou, Corentin, Lacroix, Juliette, Chommeloux, Guillaume, Lebreton, Michael A, Matthay, Sophie, Provenchere, Erwan, Flécher, André, Vincentelli, James T, Ross, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CHU Pontchaillou [Rennes], Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Nanomédecine Régénérative (NanoRegMed), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), CHU Strasbourg, Nouvel Hôpital Civil de Strasbourg, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Henri Mondor, Hôpital de la Timone [CHU - APHM] (TIMONE), Hôpital Bicêtre, Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service de Cardiologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre hospitalier régional Metz-Thionville (CHR Metz-Thionville), CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), Biologie des maladies cardiovasculaires = Biology of Cardiovascular Diseases, Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Bordeaux [Bordeaux], Hypertension pulmonaire : physiopathologie et innovation thérapeutique (HPPIT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Hôpital Marie-Lannelongue, Groupe Hospitalier Paris Saint-Joseph (hpsj), Centre Hospitalier Universitaire de Reims (CHU Reims), Université de Reims Champagne-Ardenne (URCA), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Franco-czech Laboratory for clinical research on obesity, Charles University [Prague] (CU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Rouen, Normandie Université (NU), Institut Mutualiste de Montsouris (IMM), Centre hospitalier Félix-Guyon [Saint-Denis, La Réunion], Centre hospitalier universitaire de Poitiers (CHU Poitiers), University of California [San Francisco] (UC San Francisco), University of California (UC), Centre d'investigation Clinique [CHU Bichat] - Épidémiologie clinique (CIC 1425), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Lille, ECMOSARS Investigators: Marc Pierrot, Sidney Chocron, Guillaume Flicoteaux, Philippe Mauriat, Hadrien Roze, Olivier Huet, Marc-Olivier Fischer, Claire Alessandri, Raphel Bellaïche, Ophélie Constant, Quentin de Roux, André Ly, Arnaud Meffert, Jean-Claude Merle, Lucile Picard, Elena Skripkina, Thierry Folliguet, Antonio Fiore, Nicolas d'Ostrevy, Marie-Catherine Morgan, Maxime Nguyen, Lucie Gaide-Chevronnay, Nicolas Terzi, Gwenhaël Colin, Olivier Fabre, Arash Astaneh, Justin Issard, Elie Fadel, Dominique Fabre, Antoine Girault, Iolande Ion, Jean Baptiste Menager, Delphine Mitilian, Olaf Mercier, François Stephan, Jacques Thes, Jerôme Jouan, Thibault Duburcq, Valentin Loobuyck, Sabrina Manganiello, Mouhammed Moussa, Agnes Mugnier, Natacha Rousse, Olivier Desebbe, Roland Henaine, Matteo Pozzi, Jean-Christophe Richard, Zakaria Riad, Christophe Guervilly, Sami Hraiech, Laurent Papazian, Matthias Castanier, Charles Chanavaz, Sebastien Gette, Guillaume Louis, Erick Portocarrero, Nicolas Bischoff, Antoine Kimmoun, Mathieu Mattei, Pierre Perez, Alexandre Bourdiol, Yannick Hourmant, Pierre-Joachim Mahé, Bertrand Rozec, Mickaël Vourc'h, Stéphane Aubert, Florian Bazalgette, Claire Roger, Pierre Jaquet, Brice Lortat-Jacob, Pierre Mordant, Patrick Nataf, Juliette Patrier, Morgan Roué, Romain Sonneville, Alexy Tran-Dinh, Paul-Henri Wicky, Charles Al Zreibi, Bernard Cholley, Yannis Guyonvarch, Sophie Hamada, Claudio Barbanti, Anatole Harrois, Jordi Matiello, Thomas Kerforne, Nicolas Brechot, Alain Combes, Jean Michel Constantin, Cosimo D'Alessandro, Pierre Demondion, Alexandre Demoule, Martin Dres, Muriel Fartoukh, Guillaume Hekimian, Charles Juvin, Pascal Leprince, David Levy, Charles Edouard Luyt, Marc Pineton de Chambrun, Matthieu Schmidt, Thibaut Schoell, Pierre Fillâtre, Nicolas Massart, Roxane Nicolas, Maud Jonas, Charles Vidal, Salvatore Muccio, Dario Di Perna, Bruno Mourvillier, Amedeo Anselmi, Karl Bounader, Maxime Esvan, Claire Fougerou-Leurent, Yoann Launey, Thomas Lebouvier, Alessandro Parasido, Florian Reizine, Philippe Seguin, Emmanuel Besnier, Dorothée Carpentier, Anne Olland, Fanny Bounes, Vincent Minville, Antoine Guillon, Yannick Fedun, James T Ross, Jonchère, Laurent, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases [IHU ICAN], Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), CHU Toulouse [Toulouse], Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre Hospitalier Universitaire de La Réunion (CHU La Réunion), University of California [San Francisco] (UCSF), University of California, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Modeling & analysis for medical imaging and Diagnosis (MYRIAD), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL)

Subjects
Cohort Studies, Male, [SDV] Life Sciences [q-bio], Anesthesiology and Pain Medicine, Extracorporeal Membrane Oxygenation, [SDV]Life Sciences [q-bio], COVID-19, Humans, Respiratory Insufficiency, Pandemics, Retrospective Studies
Abstract

Background Despite expanding use, knowledge on extracorporeal membrane oxygenation support during the COVID-19 pandemic remains limited. The objective was to report characteristics, management, and outcomes of patients receiving extracorporeal membrane oxygenation with a diagnosis of COVID-19 in France and to identify pre-extracorporeal membrane oxygenation factors associated with in-hospital mortality. A hypothesis of similar mortality rates and risk factors for COVID-19 and non–COVID-19 patients on venovenous extracorporeal membrane oxygenation was made. Methods The Extracorporeal Membrane Oxygenation for Respiratory Failure and/or Heart failure related to Severe Acute Respiratory Syndrome-Coronavirus 2 (ECMOSARS) registry included COVID-19 patients supported by extracorporeal membrane oxygenation in France. This study analyzed patients included in this registry up to October 25, 2020, and supported by venovenous extracorporeal membrane oxygenation for respiratory failure with a minimum follow-up of 28 days after cannulation. The primary outcome was in-hospital mortality. Risk factors for in-hospital mortality were analyzed. Results Among 494 extracorporeal membrane oxygenation patients included in the registry, 429 were initially supported by venovenous extracorporeal membrane oxygenation and followed for at least 28 days. The median (interquartile range) age was 54 yr (46 to 60 yr), and 338 of 429 (79%) were men. Management before extracorporeal membrane oxygenation cannulation included prone positioning for 411 of 429 (96%), neuromuscular blockage for 419 of 427 (98%), and NO for 161 of 401 (40%). A total of 192 of 429 (45%) patients were cannulated by a mobile extracorporeal membrane oxygenation unit. In-hospital mortality was 219 of 429 (51%), with a median follow-up of 49 days (33 to 70 days). Among pre-extracorporeal membrane oxygenation modifiable exposure variables, neuromuscular blockage use (hazard ratio, 0.286; 95% CI, 0.101 to 0.81) and duration of ventilation (more than 7 days compared to less than 2 days; hazard ratio, 1.74; 95% CI, 1.07 to 2.83) were independently associated with in-hospital mortality. Both age (per 10-yr increase; hazard ratio, 1.27; 95% CI, 1.07 to 1.50) and total bilirubin at cannulation (6.0 mg/dl or more compared to less than 1.2 mg/dl; hazard ratio, 2.65; 95% CI, 1.09 to 6.5) were confounders significantly associated with in-hospital mortality. Conclusions In-hospital mortality was higher than recently reported, but nearly half of the patients survived. A high proportion of patients were cannulated by a mobile extracorporeal membrane oxygenation unit. Several factors associated with mortality were identified. Venovenous extracorporeal membrane oxygenation support should be considered early within the first week of mechanical ventilation initiation. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Published
2022

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