Browsing by Author "Ait Hssain, Ali"

Now showing 1 - 1 of 1
  • Thumbnail Image
    Item
    Extracorporeal membrane oxygenation for tuberculosis-related acute respiratory distress syndrome: An international multicentre retrospective cohort study
    (2024) Ait Hssain, Ali; Petit, Matthieu; Wiest, Clemens; Simon, Laura; Al-Fares, Abdulrahman A.; Hany, Ahmed; Garcia-Gomez, Dafna I.; Besa, Santiago; Nseir, Saad; Guervilly, Christophe; Alqassem, Wael; Lesouhaitier, Mathieu; Chelaru, Adrian; Sin, Simon W.; Roncon-Albuquerque, Roberto; Giani, Marco; Lepper, Philipp M.; Lavillegrand, Jean-Rémi; Park, Sunghoon; Schellongowski, Peter; Fawzy Hassan, Ibrahim; Combes, Alain; Sonneville, Romain; Schmidt, Matthieu; Salas Villarroel, Patricio; Bravo Morales, Sebastián
    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.