Journal of Clinical Anesthesia and Research
ISSN: 2577-3003 | DOI: 10.64030/2577-3003
Odontuya Naimanjin, Munkh-Ochir Lhagvasuren, Tulga Ganbat, Tsengelmaa Jamiyan, Bayarmaa Enkhbat
Introduction: On January 18, 2022, the Ministry of Health of Mongolia issued Order No. A/33, titled "On the new approval of temporary guidelines for the diagnosis and treatment of the novel coronavirus infection (COVID-19)." According to this order, extracorporeal membrane oxygenation (ECMO) therapy is recommended for managing severe cases of acute respiratory distress syndrome (ARDS). In August 2020, to enhance preparedness for potential outbreaks of a novel coronavirus, the First State Central Hospital (FSCH) made operational its first heart and lung replacement ECMO machine. Presently, a total of four such machines are operational across the nation. In our nation, the aforementioned treatment was effectively implemented for the first time during the epidemic at the National Center for Communicable Diseases (NCCD) in February 2021, facilitated by the ECMO treatment team associated with the First State Central Hospital (FSCH). Our study was based on the fact that VV-ECMO has been introduced in the medical care services of our country in the most severe cases of COVID-19, yet no significant work has been done to study its complications and mortality. The aim of the study is to investigate various risk factors influencing mortality in severe cases of COVID-19 and to assess the outcomes of VV-ECMO therapy in Mongolia.
Materials and Methods: The study was conducted using a hospital-based retrospective design. The study focused on 66 severe COVID-19 cases admitted to the Intensive Care Units of the National Center for Communicable Diseases (NCCD), First State Central Hospital (FSCH), and Military Central Hospital from February 2021 to July 2022. Data regarding 22 cases that underwent VV-ECMO therapy for respiratory failure with infection, along with 44 patients who met the criteria for VV-ECMO therapy but did not receive it, were retrieved from electronic medical records and intensive care checklists utilizing designated research forms. Statistical analysis of the research data was conducted using SPSS 25 software.
Results: The average age of the 66 cases included in our study was 53±11.7 (ranging from 23 to 69) years, with 54.5% (36) being women and 45.5% (30) men. Among cases without VV-ECMO therapy, 4.5% (2) were treated and 95.5% (42) died. Of the cases receiving VV-ECMO therapy, 36.4% (8) were treated and 63.6% (14) died. In instances of VV-ECMO therapy, younger age (p=0.001), higher Murray score or lung injury score (p=0.023), and unvaccinated status (p=0.002) demonstrated statistically significant differences. Multivariate regression analysis revealed that VV-ECMO therapy (HR 0.307, 95% CI 0.131-0.722, p=0.007) significantly decreased the risk of death.
Conclusion: 1. In severe cases of COVID-19, ECMO therapy is predominantly administered to young individuals, patients with significant lung tissue damage, and those who are unvaccinated. The application of VV-ECMO therapy has reduced the risk of death by 70%. 2. In severe cases of COVID-19, the risk of death is increased by blood acidosis, kidney failure, and acute inflammatory complications. Conversely, the risk of death is reduced by adequate sleep, sedation, prone positioning, and muscle relaxation therapy.