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Multicenter Study
. 2024 Oct 9;28(1):332.
doi: 10.1186/s13054-024-05110-y.

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

Ali Ait Hssain  1 , Matthieu Petit  2 , Clemens Wiest  3 , Laura Simon  4 , Abdulrahman A Al-Fares  5 , Ahmed Hany  6 , Dafna I Garcia-Gomez  7 , Santiago Besa  8 , Saad Nseir  9 , Christophe Guervilly  10 , Wael Alqassem  11 , Mathieu Lesouhaitier  12 , Adrian Chelaru  13 , Simon Wc Sin  14 , Roberto Roncon-Albuquerque Jr  15 , Marco Giani  16   17 , Philipp M Lepper  18 , Jean-Rémi Lavillegrand  19 , Sunghoon Park  20 , Peter Schellongowski  21 , Ibrahim Fawzy Hassan  1 , Alain Combes  22 , Romain Sonneville  13 , Matthieu Schmidt  23   24 ; TB ECMO study group
Affiliations
Multicenter Study

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

Ali Ait Hssain et al. Crit Care. .

Abstract

Objective: To 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.

Methods: An international multicenter retrospective study was conducted in 20 ECMO centers across 13 countries between 2002 and 2022.

Results: We 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.

Conclusion: The 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.

Keywords: Acute respiratory distress syndrome; Extracorporeal membrane oxygenation; Miliary; Outcome; Tuberculosis.

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Conflict of interest statement

Dr. Peter Schellongowski reports grants from the European Commission and the European Society of Intensive Care Medicine, and lecture fees from Fresenius Medical. Dr Romain Sonneville reports grants from the French Ministry of Health and LFB. Dr. Saad Nseir reports MSD, Pfizer, Biomérieux, Fisher and Paykel, Medtronic, and Shionogi lecture fees. Dr. Matthieu Schmidt reports lecture fees from Getinge, Dräger, Baxter, and Fresenius Medical reports lecture fees. Dr. Alain Combes reports grants from Getinge, and personal fees from Getinge, Baxter, and Xenios outside the submitted work. No other disclosures were reported.

Figures

Fig. 1
Fig. 1
Distribution of the number of patients included per country
Fig. 2
Fig. 2
Daily patient’s disposition according to the type of tuberculosis. The plot illustrates the actual state occupation probabilities of being in each endpoint state—On-ECMO, In-ICU & weaned-off ECMO, Alive & out of ICU or Dead—over the 90 days following ECMO implantation. The respective probabilities and mean lengths of stay (with 95% confidence intervals) in each of these four states are reported in eFile 3. See eFile 1 for all possible transition probabilities (with 95% confidence intervals) from one state to another over time. ECMO, extracorporeal membrane oxygenation; ICU, intensive care unit
Fig. 3
Fig. 3
Unadjusted and adjusted (dotted lines) Kaplan–Meier survival estimates according to the type of tuberculosis (cavitary vs. miliary TB) in A all the cohort (n = 79) and B patients treated with VV ECMO (n = 68)
See this image and copyright information in PMC

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