The impact of bacterial superinfections on the outcome of critically ill patients with COVID-19 associated acute respiratory distress syndrome (ARDS) - a single-centre, observational cohort study

INTRODUCTION

Bacterial superinfections are common in severely ill COVID-19 patients and could be associated with a significant increase in morbidity and mortality.

MATERIAL AND METHODS

We assessed 29 critically ill patients treated in a university hospital's intensive care unit (ICU). Each patient required mechanical ventilation due to COVID-19-induced acute respiratory distress syndrome (ARDS). Fifteen patients who required venovenous extracorporeal membrane oxygenation (VV-ECMO) support (ECMO group) were compared to a control group (CON group) of 14 individuals without ECMO. This study aimed to assess the prevalence of superinfection in both studied groups. Moreover, we evaluated mortality, length of stay in the ICU, positive culture results, antibiotics used during treatment, and the impact of immunomodulatory drugs on secondary infections.

RESULTS

We did not find a difference in the number of superinfections between the ECMO and CON groups (11 vs. 10, P = 1.0). The mortality rate was 67% in the ECMO group and 64% in the CON group ( P = 1.0). The patients in both groups had similar numbers of positive culture results and days in the ICU prior to the detection of a positive culture. Antibiotics were administered to ten patients in the ECMO and eight patients in the CON group. The mortality rate was 81% in patients with superinfection versus 25% in those without co-infection ( P = 0.009). We found a negative impact of urea concentration on mortality in our cohort, with an odds ratio of 0.942 (0.891-0.996, P = 0.034).

CONCLUSIONS

Our results suggest that bacterial superinfection in COVID-19 patients negatively impacted survival in the ICU. VV-ECMO support in COVID-19 patients does not seem to improve the outcomes of patients with severe ARDS.

[The use of ExtraCorporeal Membrane Oxygenation (ECMO) in severe hypothermia associated with cardiac arrest]

The use of extracorporeal membrane oxygenation (ECMO) in severe hypothermia associated with cardiac arrest has become a more frequent warming technique in specialized centers over the years with better survival outcomes compared to traditional rewarming methods. We show that a full recovery is possible, even after prolonged resuscitation. We report the case of a 36-year old male who survived approximately 4 hours of cardiopulmonary resuscitation following an unknown duration of asystole in the context of severe accidental hypothermia (24°C). Normal sinus rhythm was obtained using a single external electric shock during the rewarming of the patient by ECMO. After a hospital stay of 17 days, there were no neurological deficits and he achieved a full recovery. Although prolonged out-of-hospital cardiac arrest has low survival rates and asystole is not generally considered as an indication for extracorporeal cardiopulmonary resuscitation (ECCPR), associated hypothermia can be a predictor of a possible positive outcome when ECMO is used as it reduces the metabolism and protects the brain, thus leading to "miraculous" recoveries with no neurological sequelae. This case demonstrates yet again the importance of advanced rewarming techniques such as ECMO in the outcome of patients with severe accidental hypothermia, even after prolonged and refractory out-of hospital cardiac arrest and when "no-flow" time is uncertain. It also highlights the need for accidental hypothermia treatment algorithms, especially in hospitals capable of ECMO rewarming, to enable more rapid decision-making.

[Acute respiratory distress revealing antisynthetase syndrome]

Antisynthetase syndrome is a clinical entity characterized by specific anti-aminoacyl-tRNA-synthetase antibodies usually associated with inflammatory myopathy and interstitial lung disease. The classic presentation of the pathology is the pulmonary interstitium involvment, wich commonly determines the global prognosis. The subsequent diagnosis of antisynthetase syndrome in patients with acute respiratory distress syndrome (ARDS) is unusual, even more so when a veino-veinous (VV) extracorporeal membrane oxygenation (ECMO) is required. This article presents a clinical case of antisynthetase syndrome with severe ARDS successfully treated with immunosuppressive agents and ECMO.