Echocardiographic Findings in Critically Ill COVID-19 Patients Treated With and Without Extracorporeal Membrane Oxygenation.

Autor: Morales Castro D; Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: diana.moralescastro@uhn.ca., Ferreyro BL; Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto, Toronto, Ontario, Canada., McAlpine D; Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada., Evangelatos N; Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada., Dragoi L; Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada., Teijeiro-Paradis R; Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada., Del Sorbo L; Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Canada., Fan E; Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Canada., Douflé G; Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Jazyk: angličtina
Zdroj: Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2024 Dec; Vol. 38 (12), pp. 3043-3054. Date of Electronic Publication: 2024 Aug 08.
DOI: 10.1053/j.jvca.2024.08.007
Abstrakt: Objectives: To describe echocardiographic findings among mechanically ventilated patients with COVID-19 acute respiratory distress syndrome, comparing those with and without venovenous extracorporeal membrane oxygenation (VV ECMO) support.
Design: Single-center, retrospective cohort study.
Setting: Intensive care unit (ICU) of a quaternary academic center.
Participants: Patients with COVID-19 admitted between March 2020 and June 2021 receiving mechanical ventilation, with an echocardiogram within 72 hours of admission.
Interventions: Admission and follow-up echocardiograms during ICU stay.
Measurements: Patient characteristics and echocardiographic findings were analyzed. Mortality odds ratio (OR) for right ventricular (RV) systolic dysfunction and acute cor pulmonale (ACP) was calculated.
Main Results: Among 242 patients, 145 (60%) received VV ECMO. Median (IQR) PaO 2 /FiO 2 was 76 (65-95) and 98 (85-140) in ECMO and non-ECMO patients, respectively (p ≤ 0.001). Initial echocardiograms showed no significant differences in left ventricular systolic dysfunction (10% v 15 %, p = 0.31) and RV systolic dysfunction (38% v. 27%, p = 0.27) between ECMO and non-ECMO patients. ACP was more frequent in the ECMO group at baseline (41% v. 26 %, p = 0.02). During the ICU stay, patients on ECMO exhibited a higher prevalence of RV systolic dysfunction (55% v 34%, p = 0.001) and ACP (51% v 26%, p = 0.002). RV systolic dysfunction (OR 1.99; 95% CI 1.09-3.63) and ACP (OR 2.95; 95% CI 1.55-5.62) on the follow-up echocardiograms were associated with higher odds of ICU mortality.
Conclusions: The prevalence of echocardiographic abnormalities, in particular RV dysfunction, was frequent among patients with COVID-19 receiving VV ECMO support and was associated with worse clinical outcomes.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Eddy Fan reports personal fees from ALung Technologies, Baxter, Getinge, Inspira, Vasomune, and Zoll Medical outside the submitted work. Lorenzo del Sorbo is the inventor of a patent licensed to SQI Diagnostic outside of the submitted work. Diana Morales Castro received a Canadian Institutes of Health Research (CIHR) Research Excellence, Diversity, and Independence (REDI) Early Career Transition Award (FN 190695). All other authors have disclosed that they do not have any conflict of interest.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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