UTILITY OF RISK CALCULATORS AND INFLAMMATORY MARKERS IN THE ASSESSMENT OF OUTCOMES FOR PATIENTS WITH COVID-19 ON EXTRACORPOREAL MEMBRANE OXYGENATION

ABSTRACT

SESSION TITLE ECMO and ARDS in COVID-19 Infections SESSION TYPE Rapid Fire Original Inv PRESENTED ON 10/17/2022 1215 pm - 115 pm PURPOSE: Before the Coronavirus disease 2019 (COVID-19) pandemic, the use of extracorporeal membrane oxygenation (ECMO) specific scoring systems have been shown to predict survival better compared to general risk scores used in the intensive care unit (ICU). However, data is lacking on the utility of these scores in predicting mortality in COVID-19 patients managed with ECMO. Also, inflammatory markers have been reported to be predictors of mortality in patients with COVID-19 but have not been studied well in ECMO patients. Our study aims to assess the utility of standard ICU [Acute Physiology And Chronic Health Evaluation (APACHE-IV)] and ECMO specific [Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP)] risk calculators along with inflammatory markers in COVID-19 patients treated with ECMO. METHODS: This study is a retrospective analysis of all adult patients with COVID-related acute respiratory distress syndrome (ARDS) admitted to the ICUs of a quaternary care hospital between 03/01/2020 and 03/31/2022 who were managed with ECMO. Demographic and clinical characteristics, inflammatory markers at the time of hospital admission, and respiratory parameters at the time of ECMO cannulation of the patients who survived were compared and analyzed with patients who did not survive. RESULTS: Of the 36 COVID-19 patients managed with ECMO during the study period, 12 (33%) patients survived. Both groups were similar in terms of age, gender, and comorbidity burden (measured by Charlson Comorbidity Index). The severity of illness at the time of ICU admission (assessed by APACHE IV score) was not significantly different between two groups [Median (IQR) = 58 (50-67) vs. 60 (52-71), p= 0.627]. D-dimers at the time of ICU admission were significantly lower in the survivor group as compared to their counterpart [Median (IQR) ng/ml = 1238 (1021-1830) vs. 2990 (1298-16583), p= 0.031]. RESP score at the time of ECMO cannulation was significantly higher among the survivors as compared to non-survivors (Mean ± SD = 3.7 ± 2.2 vs. 1.3 ± 3.5, p= 0.042). CONCLUSIONS: Our study showed that higher D-dimers at the time of hospital admission and lower RESP score at the time of ECMO cannulation are associated with increased morality in patients with COVID-19 related ARDS placed on ECMO. Knowledge of these factors may assist with determining appropriate candidates for this limited resource as well as may enhance outcome predictions. Our study is limited by a relatively small sample size and therefore larger studies will be needed to validate our findings. CLINICAL IMPLICATIONS This study shows that similar to pre-COVID studies, RESP score be useful in risk stratification of COVID-19 patients treated with ECMO. DISCLOSURES No relevant relationships by ALEENA ARSHAD No relevant relationships by Dipak Chandy No relevant relationships by Oleg Epelbaum No relevant relationships by Daniel Greenberg No relevant relationships by Theresa Henson No relevant relationships by Areen Pitaktong No relevant relationships by Hamid Yaqoob