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Worse survival in patients with right ventricular dysfunction and COVID-19-associated acute respiratory distress requiring extracorporeal membrane oxygenation: A multicenter study from the ORACLE Group.
Cain, Michael T; Taylor, Lauren J; Colborn, Kathryn; Teman, Nicholas R; Hoffman, Jordan; Mayer, Kirby P; Etchill, Eric W; Sevin, Carla M; Jaishankar, Sruthi; Ramanan, Raj; Enfield, Kyle; Zwischenberger, Joseph B; Jolley, Sarah E; Rove, Jessica Y.
  • Cain MT; Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo.
  • Taylor LJ; Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo.
  • Colborn K; Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo.
  • Teman NR; Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
  • Hoffman J; Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo.
  • Mayer KP; Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Ky.
  • Etchill EW; Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Md.
  • Sevin CM; Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University, Nashville, Tenn.
  • Jaishankar S; University of Pittsburgh School of Medicine, Pittsburgh, Pa.
  • Ramanan R; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pa.
  • Enfield K; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia, Charlottesville, Va.
  • Zwischenberger JB; Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky, Lexington, Ky.
  • Jolley SE; Division of Pulmonary Sciences and Critical Care, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo.
  • Rove JY; Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo. Electronic address: jessica.rove@cuanschutz.edu.
J Thorac Cardiovasc Surg ; 2022 Dec 21.
Article in English | MEDLINE | ID: covidwho-2228489
ABSTRACT

OBJECTIVE:

We sought to determine the impact of right ventricular dysfunction on the outcomes of mechanically ventilated patients with COVID-19 requiring veno-venous extracorporeal membrane oxygenation.

METHODS:

Six academic centers conducted a retrospective analysis of mechanically ventilated patients with COVID-19 stratified by support with veno-venous extracorporeal membrane oxygenation during the first wave of the pandemic (March to August 2020). Echocardiograms performed for clinical indications were reviewed for right and left ventricular function. Baseline characteristics, hospitalization characteristics, and survival were compared.

RESULTS:

The cohort included 424 mechanically ventilated patients with COVID-19, 126 of whom were cannulated for veno-venous extracorporeal membrane oxygenation. Right ventricular dysfunction was observed in 38.1% of patients who received extracorporeal membrane oxygenation and 27.4% of patients who did not receive extracorporeal membrane oxygenation with an echocardiogram. Biventricular dysfunction was observed in 5.5% of patients who received extracorporeal membrane oxygenation. Baseline patient characteristics were similar in both the extracorporeal membrane oxygenation and non-extracorporeal membrane oxygenation cohorts stratified by the presence of right ventricular dysfunction. In the extracorporeal membrane oxygenation cohort, right ventricular dysfunction was associated with increased inotrope use (66.7% vs 24.4%, P < .001), bleeding complications (77.1% vs 53.8%, P = .015), and worse survival independent of left ventricular dysfunction (39.6% vs 64.1%, P = .012). There was no significant difference in days ventilated before extracorporeal membrane oxygenation, length of hospital stay, hours on extracorporeal membrane oxygenation, duration of mechanical ventilation, vasopressor use, inhaled pulmonary vasodilator use, infectious complications, clotting complications, or stroke. The cohort without extracorporeal membrane oxygenation cohort demonstrated no statistically significant differences in in-hospital outcomes.

CONCLUSIONS:

The presence of right ventricular dysfunction in patients with COVID-19-related acute respiratory distress syndrome supported with veno-venous extracorporeal membrane oxygenation was associated with increased in-hospital mortality. Additional studies are required to determine if mitigating right ventricular dysfunction in patients requiring veno-venous extracorporeal membrane oxygenation improves mortality.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Language: English Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Language: English Year: 2022 Document Type: Article