tetano
Editor, Senior Moderator
World J Cardiol
. 2023 Apr 26;15(4):165-173.
doi: 10.4330/wjc.v15.i4.165. Right ventricle dysfunction does not predict mortality in patients with SARS-CoV-2-related acute respiratory distress syndrome on extracorporeal membrane oxygenation support
Chiara Lazzeri[SUP] 1 [/SUP], Manuela Bonizzoli[SUP] 2 [/SUP], Stefano Batacchi[SUP] 2 [/SUP], Giovanni Cianchi[SUP] 2 [/SUP], Andrea Franci[SUP] 2 [/SUP], Filippo Socci[SUP] 2 [/SUP], Marco Chiostri[SUP] 2 [/SUP], Adriano Peris[SUP] 2 [/SUP]
Affiliations
Background: The prognostic role of right ventricle dilatation and dysfunction (RVDD) has not been elucidated in patients with coronavirus disease (COVID)-related respiratory failure refractory to standard treatment needing extracorporeal membrane oxygenation (ECMO) support.
Aim: To assess whether pre veno-venous (VV) ECMO RVDD were related to in-intensive care unit (ICU) mortality.
Methods: We enrolled 61 patients with COVID-related acute respiratory distress syndrome refractory to conventional treatment submitted to VV ECMO and consecutively admitted to our ICU (an ECMO referral center) from 31[SUP]th[/SUP] March 2020 to 31[SUP]th[/SUP] August 2021. An echocardiographic exam was performed immediately before VV ECMO implantation.
Results: Males were prevalent (73.8%) and patients with a body mass index > 30 kg/m[SUP]2[/SUP] were the majority (46/61, 75%). The overall in-ICU mortality rate was 54.1% (33/61). RVDD was detectable in more than half of the population (34/61, 55.7%) and associated with higher simplified organ functional assessment (SOFA) values (P = 0.029) and a longer mechanical ventilation duration prior to ECMO support (P = 0.046). Renal replacement therapy was more frequently needed in RVDD patients (P = 0.002). A higher in-ICU mortality (P = 0.024) was observed in RVDD patients. No echo variables were independent predictors of in-ICU death.
Conclusion: In patients with COVID-related respiratory failure on ECMO support, RVDD (dilatation and dysfunction) is a common finding and identifies a subset of patients characterized by a more severe disease (as indicated by higher SOFA values and need of renal replacement therapy) and by a higher in-ICU mortality. RVDD (also when considered separately) did not result independently associated with in-ICU mortality in these patients.
Keywords: Acute respiratory distress syndrome; COVID; Echocardiography; Mortality; Right ventricle; Right ventricle-pulmonary circulation coupling.
. 2023 Apr 26;15(4):165-173.
doi: 10.4330/wjc.v15.i4.165. Right ventricle dysfunction does not predict mortality in patients with SARS-CoV-2-related acute respiratory distress syndrome on extracorporeal membrane oxygenation support
Chiara Lazzeri[SUP] 1 [/SUP], Manuela Bonizzoli[SUP] 2 [/SUP], Stefano Batacchi[SUP] 2 [/SUP], Giovanni Cianchi[SUP] 2 [/SUP], Andrea Franci[SUP] 2 [/SUP], Filippo Socci[SUP] 2 [/SUP], Marco Chiostri[SUP] 2 [/SUP], Adriano Peris[SUP] 2 [/SUP]
Affiliations
- PMID: 37124973
- PMCID: PMC10130894
- DOI: 10.4330/wjc.v15.i4.165
Background: The prognostic role of right ventricle dilatation and dysfunction (RVDD) has not been elucidated in patients with coronavirus disease (COVID)-related respiratory failure refractory to standard treatment needing extracorporeal membrane oxygenation (ECMO) support.
Aim: To assess whether pre veno-venous (VV) ECMO RVDD were related to in-intensive care unit (ICU) mortality.
Methods: We enrolled 61 patients with COVID-related acute respiratory distress syndrome refractory to conventional treatment submitted to VV ECMO and consecutively admitted to our ICU (an ECMO referral center) from 31[SUP]th[/SUP] March 2020 to 31[SUP]th[/SUP] August 2021. An echocardiographic exam was performed immediately before VV ECMO implantation.
Results: Males were prevalent (73.8%) and patients with a body mass index > 30 kg/m[SUP]2[/SUP] were the majority (46/61, 75%). The overall in-ICU mortality rate was 54.1% (33/61). RVDD was detectable in more than half of the population (34/61, 55.7%) and associated with higher simplified organ functional assessment (SOFA) values (P = 0.029) and a longer mechanical ventilation duration prior to ECMO support (P = 0.046). Renal replacement therapy was more frequently needed in RVDD patients (P = 0.002). A higher in-ICU mortality (P = 0.024) was observed in RVDD patients. No echo variables were independent predictors of in-ICU death.
Conclusion: In patients with COVID-related respiratory failure on ECMO support, RVDD (dilatation and dysfunction) is a common finding and identifies a subset of patients characterized by a more severe disease (as indicated by higher SOFA values and need of renal replacement therapy) and by a higher in-ICU mortality. RVDD (also when considered separately) did not result independently associated with in-ICU mortality in these patients.
Keywords: Acute respiratory distress syndrome; COVID; Echocardiography; Mortality; Right ventricle; Right ventricle-pulmonary circulation coupling.