• Crit Care · Oct 2024

    Multicenter Study

    Extracorporeal membrane oxygenation for tuberculosis-related acute respiratory distress syndrome: An international multicentre retrospective cohort study.

    • Ait HssainAliAMedical Intensive Care Unit, Hamad General Hospital, Department of Medicine, Weill Cornell Medical College Doha, College of Health and Life Science, Hamad Bin Khalifa University, Doha, Qatar., Matthieu Petit, Clemens Wiest, Laura Simon, Abdulrahman A Al-Fares, Ahmed Hany, Dafna I Garcia-Gomez, Santiago Besa, Saad Nseir, Christophe Guervilly, Wael Alqassem, Mathieu Lesouhaitier, Adrian Chelaru, Simon Wc Sin, Roberto Roncon-Albuquerque, Marco Giani, Philipp M Lepper, Jean-Rémi Lavillegrand, Sunghoon Park, Peter Schellongowski, Fawzy HassanIbrahimIMedical Intensive Care Unit, Hamad General Hospital, Department of Medicine, Weill Cornell Medical College Doha, College of Health and Life Science, Hamad Bin Khalifa University, Doha, Qatar., Alain Combes, Romain Sonneville, Matthieu Schmidt, and TB ECMO study group.
    • Medical Intensive Care Unit, Hamad General Hospital, Department of Medicine, Weill Cornell Medical College Doha, College of Health and Life Science, Hamad Bin Khalifa University, Doha, Qatar.
    • Crit Care. 2024 Oct 9; 28 (1): 332332.

    ObjectiveTo report the outcomes of patients with severe tuberculosis (TB)-related acute respiratory distress syndrome (ARDS) on extracorporeal membrane oxygenation (ECMO), including predictors of 90-day mortality and associated complications.MethodsAn international multicenter retrospective study was conducted in 20 ECMO centers across 13 countries between 2002 and 2022.ResultsWe collected demographic data, clinical details, ECMO-related complications, and 90-day survival status for 79 patients (median APACHE II score of 20 [25th to 75th percentile, 16 to 28], median age 39 [28 to 48] years, PaO2/FiO2 ratio of 69 [55 to 82] mmHg before ECMO) who met the inclusion criteria. Thoracic computed tomography showed that 61 patients (77%) had cavitary TB, while 18 patients (23%) had miliary TB. ECMO-related complications included major bleeding (23%), ventilator-associated pneumonia (41%), and bloodstream infections (32%). The overall 90-day survival rate was 51%, with a median ECMO duration of 20 days [10 to 34] and a median ICU stay of 42 days [24 to 65]. Among patients on VV ECMO, those with miliary TB had a higher 90-day survival rate than those with cavitary TB (90-day survival rates of 81% vs. 46%, respectively; log-rank P = 0.02). Multivariable analyses identified older age, drug-resistant TB, and pre-ECMO SOFA scores as independent predictors of 90-day mortality.ConclusionThe use of ECMO for TB-related ARDS appears to be justifiable. Patients with miliary TB have a much better prognosis compared to those with cavitary TB on VV ECMO.© 2024. The Author(s).

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