Abstract:

Objective: To investigate the clinical characteristics and treatment outcomes of patients with severe pulmonary tuberculosis (PTB)-associated acute respiratory distress syndrome (ARDS) who underwent extracorporeal membrane oxygenation (ECMO), and to provide evidence to inform clinical decision-making in this high-risk population. Methods: A retrospective observational study was conducted, enrolling 13 patients with severe PTB-associated ARDS who received ECMO support in the Intensive Care Unit (ICU) of Wuhan Pulmonary Hospital between October 2020 and October 2024. Clinical data were systematically collected, including demographic information, comorbidities, disease severity scores, radiological and microbiological findings, as well as treatment-related variables such as anti-TB regimens, respiratory support strategies, ECMO configurations, use of prone positioning, and corticosteroid administration. Outcomes assessed included survival rates, durations of ECMO support, mechanical ventilation, and ICU stay, along with ECMO-related complications. Results: Of the 13 patients included in the study, 11 (84.6%) were male, with a median age of 51 years and a median disease duration of 40 days. The mean Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score was 25.23±7.11, and the median Sequential Organ Failure Assessment (SOFA) score was 7 (interquartile range (IQR): 4, 10). During ECMO support, 12 patients (92.3%) developed secondary infections with other pathogens. Six patients were newly diagnosed with PTB and had not received anti-TB treatment prior to admission. Positive diagnostic results were observed in 10 patients (76.9%) via metagenomic next-generation sequencing (mNGS) or GeneXpert MTB/RIF, in 12 (92.3%) via TB-DNA testing, and in 8 (61.5%) via acid-fast bacilli (AFB) smear. Infiltrative PTB was identified in 8 patients (61.5%). Prone position ventilation was applied in 7 patients (53.8%) before ECMO initiation and in 6 patients (46.2%) during ECMO therapy. Venovenous ECMO (VV-ECMO) was employed in 10 patients (76.9%), venoarterial ECMO (VA-ECMO) in 2 patients (15.4%), and 1 patient (7.7%) underwent conversion from VV-ECMO to VA-ECMO. ECMO-related complications occurred in 6 patients (46.2%), with gastrointestinal bleeding reported in 5 cases. The duration of ECMO support ranged from 1 to 88 days. The median durations (IQR) were: 13 (9, 31) days for ECMO, 27 (16, 47) days for mechanical ventilation, and 32 (23, 57) days for ICU stay. Six patients (46.2%) showed clinical improvement and were discharged. The post-discharge survival rates at 28 and 60 days were 46.2% (6/13) and 30.8% (4/13), respectively. Conclusion: ECMO may improve survival in patients with severe PTB-associated ARDS and appears to offer a reasonable balance of efficacy and safety. However, careful patient selection and comprehensive assessment of disease severity are essential before ECMO initiation, with a thorough evaluation of potential benefits and risks.

Key words: Tuberculosis, pulmonary, Intensive care, Ventilators, mechanical, Respiratory distress syndrome, adult, Extracorporeal membrane oxygenation