ABSTRACT
Background: Lung protective ventilation plays a crucial role in the management of patients with COVID-19 ARDS treated with VV-ECMO. We hypothesized that increasingly protective ventilator settings may be associated with improved lung recovery by reducing ventilator induced lung injury. Method(s): We performed a retrospective cohort study of all patients treated with VV-ECMO for COVID-19 at NYU Langone Medical Center from March 2020 to June 2020. Ventilator data including tidal volume (cc/ kg predicted body weight), peak airway pressure, PEEP, Driving pressure (DP), Respiratory Rate, FiO2, lung compliance, and mechanical power were obtained. Pulmonary function test (PFT) results, 6-minute walk test results, and quantitative chest CT scores were obtained from the first outpatient follow up assessment. Bivariate and multivariate analysis correlating ventilator data with lung function and CT outcomes was performed. Result(s): 30 COVID-19 patients were treated with VV-ECMO during the study period, of which 26 survived without lung transplantation and 12 completed follow up assessment at a median of 106 days post ECMO decannulation. Multivariate LASSO regression model results;FEV1: DP (beta=-5.535), Respiratory Rate (beta=-0.370), compliance (beta=0.467), FVC: DP (beta=-4.08), compliance (beta=0.875), preECMO tidal volume (beta=-0.0008), TLC: DP (beta=-4.518), ECMO sweep (beta=-0.598), DLCO: peak airway presure (beta=-1.836), 6MWT distance: compliance (beta=1.436), Chest CT total opacity score: DP(beta=-0.60), preECMO tidal volume(beta=-0.0033). Conclusion(s): Driving pressure and peak airway pressure during VV-ECMO had the strongest associations with improved short-term follow up lung volumes, DLCO, and chest CT outcomes in VV-ECMO treated COVID-19 survivors.
ABSTRACT
Background The long-term effects of SARS-CoV-2 are just now coming to light. These remaining symptoms are sometimes referred to as “Post-COVID syndrome.” The types and incidence of prolonged symptoms from the acute viral illness are unknown. Yet understanding the prevalence and which symptoms persist would help normalize post COVID syndrome and help providers recognize these issues in their COVID survivors. Methods We conducted a single-center retrospective analysis with patients discharged from New York University (NYU) Langone Hospital with primary diagnosis of COVID-19. Each patient was then called and given a phone survey 45-60 days post discharge. In the survey they were consented and asked about residual symptoms. Study data were collected and managed using REDCap electronic data capture tools hosted at NYU hospital. Patient surveys were then merged with their medical record from their COVID hospitalization. All statistical analysis was processed in SPSS. The study was approved through our institutional IRB. Results Overall, 101 patients were surveyed post discharge. The median age was 59, with the most common co-morbidities being DM (N = 20) and HTN (N = 45). Most patients (N= 57) reported residual lethargy and malaise as compared to prior. Thirty-eight patients continued to have limited exercise tolerance. Thirty- eight patients experienced shortness of breath more than prior to getting COVID, while 24 patients continued to have shortness of breath while walking within their house. Some experienced chest pain with breathing (N=5), dry cough (N=14) and productive cough (N=5) that was not present prior to COVID infection. Conclusion We found that COVID patients continued to have symptoms 2 months post discharge. More than half of patients reached reported continued lethargy post discharge. Other symptoms were quite common, with 1/4-1/3 having continued shortness of breath and decreased exercise tolerance. The full pathophysiology between continued symptoms and post COVID syndrome is not yet known;however, clinicians need to understand the prevalence to treat patients accordingly. Physicians should help to normalize these symptoms to patients. Treatment should include supportive care such as rehab and physical therapy with consideration of referral to post COVID centers.