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Extracorporeal Life Support for Severe Acute Chest Syndrome in Adult Sickle Cell Disease

A Preliminary Report

Boissier, Florence, MD, PhD1,2,3; Bagate, François, MD1,4; Schmidt, Matthieu, MD, PhD5; Labbé, Vincent, MD6,7; Kimmoun, Antoine, MD, PhD8; Fartoukh, Muriel, MD, PhD6,7; Mekontso Dessap, Armand, MD, PhD1,4

doi: 10.1097/CCM.0000000000003628
Online Brief Report

Objectives: Extracorporeal life support could be helpful for severe acute chest syndrome in adults sickle cell disease, because of the frequent hemodynamic compromise in this setting, including acute pulmonary vascular dysfunction and right ventricular failure. The aim of this study was to report the extracorporeal life support experience for severe acute chest syndrome in four referral centers in France.

Design: The primary endpoint of this multicentric retrospective study was ICU survival of patients with severe acute chest syndrome managed with extracorporeal life support. Secondary endpoints included comparisons between survivors and nonsurvivors.

Setting: We performed this study between January 2009 and July 2017 in four referral centers in France.

Patients: We included adult patients (age > 18 yr) with sickle cell disease, admitted for severe acute chest syndrome and who required extracorporeal life support during the ICU stay.

Interventions: The study was observational.

Measurements and Main Results: Over the 8-year period, 22 patients with sickle cell disease required extracorporeal life support for severe acute chest syndrome, including 10 (45%) veno-venous and 12 (55%) veno-arterial extracorporeal life support. In-ICU mortality was high (73%). Nonsurvivors had a higher severity at extracorporeal life support implantation, as assessed by their Vasoactive-Inotrope Score and number of organ failures.

Conclusions: Our study shows that outcome is impaired in sickle cell disease patients receiving extracorporeal life support while in severe multiple organ failure. Further studies are needed to evaluate selection criteria in this setting.

1Service de Réanimation médicale, DHU A-TVB, Hôpital Henri Mondor, AP-HP, Créteil, France.

2Service de Réanimation médicale, CHU de Poitiers, Poitiers, France.

3INSERM CIC 1402 (ALIVE group), Université de Poitiers, Poitiers, France.

4GRC CARMAS, IMRB, Faculté de Médecine de Créteil, Université Paris Est Créteil, Créteil, France.

5Medical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris, France.

6Service de Réanimation polyvalente, Hôpital Tenon, AP-HP, Paris, France.

7UPMC Université Paris 6, Paris, France.

8Service de Réanimation et Médecine Intensive Brabois, Institut Louis Mathieu, CHRU de Nancy, Vandoeuvre-les-Nancy, France.

Drs. Boissier and Bagate contributed equally to this work.

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Dr. Kimmoun received funding from Gilead, MSD, and Baxter; he disclosed that Maquet provides circuit for experimental research. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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