Extracorporeal Membrane Oxygenation with Right Ventricular Assist Device for COVID-19 ARDS

Autor: Gulrayz Ahmed, Rebekah J. Walker, Michael T. Cain, Sherry-Ann Brown, Nathan J. Smith, Christopher J. Roberts, Hemanckur Makker, Octavio Falcucci, Lucian A. Durham, David L. Joyce, Mark Barash, Dong Wang, Rahul Nanchal, Pippa Simpson
Rok vydání: 2021
Předmět:
Adult
Male
right ventricular assist device
ARDS
Critical Care
Ventricular Dysfunction
Right
medicine.medical_treatment
Severity of Illness Index
Article
law.invention
03 medical and health sciences
0302 clinical medicine
law
Severity of illness
medicine
Extracorporeal membrane oxygenation
Humans
Hospital Mortality
Retrospective Studies
Heart Failure
Mechanical ventilation
Respiratory Distress Syndrome
business.industry
Acute kidney injury
COVID-19
Retrospective cohort study
Middle Aged
extracorporeal membrane oxygenation
acute respiratory distress syndrome
medicine.disease
Combined Modality Therapy
Respiration
Artificial
Intensive care unit
Right Ventricular Assist Device
Intensive Care Units
Treatment Outcome
030220 oncology & carcinogenesis
Anesthesia
Female
030211 gastroenterology & hepatology
Surgery
Heart-Assist Devices
business
Zdroj: The Journal of Surgical Research
ISSN: 0022-4804
DOI: 10.1016/j.jss.2021.03.017
Popis: BACKGROUND: Right ventricular failure is an underrecognized consequence of COVID-19 pneumonia. Those with severe disease are treated with extracorporeal membrane oxygenation (ECMO) but with poor outcomes. Concomitant right ventricular assist device (RVAD) may be beneficial. METHODS: A retrospective analysis of intensive care unit patients admitted with COVID-19 ARDS (Acute Respiratory Distress Syndrome) was performed. Nonintubated patients, those with acute kidney injury, and age > 75 were excluded. Patients who underwent RVAD/ECMO support were compared with those managed via invasive mechanical ventilation (IMV) alone. The primary outcome was in-hospital mortality. Secondary outcomes included 30-d mortality, acute kidney injury, length of ICU stay, and duration of mechanical ventilation. RESULTS: A total of 145 patients were admitted to the ICU with COVID-19. Thirty-nine patients met inclusion criteria. Of these, 21 received IMV, and 18 received RVAD/ECMO. In-hospital (52.4 versus 11.1%, P = 0.008) and 30-d mortality (42.9 versus 5.6%, P= 0.011) were significantly lower in patients treated with RVAD/ECMO. Acute kidney injury occurred in 15 (71.4%) patients in the IMV group and zero RVAD/ECMO patients (P< 0.001). ICU (11.5 versus 21 d, P= 0.067) and hospital (14 versus 25.5 d, P = 0.054) length of stay were not significantly different. There were no RVAD/ECMO device complications. The duration of mechanical ventilation was not significantly different (10 versus 5 d, P = 0.44). CONCLUSIONS: RVAD support at the time of ECMO initiation resulted in the no secondary end-organ damage and higher in-hospital and 30-d survival versus IMV in specially selected patients with severe COVID-19 ARDS. Management of severe COVID-19 ARDS should prioritize right ventricular support.
Databáze: OpenAIRE
Externí odkaz: