TOPIC: Critical Care
TYPE: Original Investigations
PURPOSE: We sought to determine the impact of right ventricular dysfunction (RVD) on outcomes of mechanically ventilated patients with COVID-19 requiring ECMO.
METHODS: Five academic centers conducted a retrospective analysis of mechanically ventilated patients with COVID-19 who were supported with ECMO. Transthoracic and transesophageal echocardiograms performed for clinical indications were reviewed for right and left ventricular function. Baseline characteristics, hospitalization characteristics and survival were compared based on the presence or absence of any RVD.
RESULTS: 359 mechanically ventilated patients with COVID-19 were included, 93 of whom were cannulated for veno-venous ECMO. 82.8% (77/93) of ECMO cohort had echocardiograms and RVD was observed in 36.4% (28/77). 44% (117/266) of the non-ECMO cohort had echocardiograms and RVD was observed in 27.3% (32/117). When both ECMO and non-ECMO cohorts were stratified by the presence of RVD, there was no difference in baseline characteristics. ECMO patients with and without RVD had no significant differences in need for therapeutic anticoagulation, blood transfusions, paralytics, vasopressors or tracheostomy. 100% of ECMO patients were treated with inhaled pulmonary vasodilators. Likewise, ECMO patients with and without RVD were no different in their receipt of investigational COVID therapy or steroids. There was no significant difference in acute kidney injury, clotting complications, intracranial hemorrhage or stroke, delirium, duration of mechanical ventilation, or discharge location. The majority of RVD in ECMO patients was isolated. Biventricular dysfunction was observed in 17.9% of ECMO patients. Isolated LV EF < 50% was observed in only 4.1% of ECMO patients. Significant differences were seen in need for inotropes (RVD: 16/28 (57.1%) versus no RVD: 12/28 (42.9%) p=0.001), and bleeding complications (RVD: 23/28 (82.1%) versus no RVD: 20/49 (40.8%) p=0.001). Additionally, there was a significant difference in hours on ECMO (RVD: median 528 hours (IQR 383.0, 774.0) versus no RVD: 310.0 (216.0, 528.0) p<0.001) and overall length of stay (RVD: median 62.0 days (IQR 36.0, 75.0) versus no RVD: 39.0 days (IQR 26.5, 53) p=0.007). There was a trend toward higher mortality associated with RVD (53.6% compared to 28.6%) but it was not statistically significant. In the non-ECMO cohort there was no difference in mortality in those with RVD 11/32 (34.4%) and no RVD 27/85 (31.8%) and the majority of RVD was isolated. Biventricular dysfunction was observed in RVD 10/32 (31.2%) and isolated LV EF < 50% was observed in only 5/85 (5.9%), p<0.001.
CONCLUSIONS: The majority of RVD observed in patients with COVID-19 who had a clinically indicated echocardiogram is independent of reduced LV function. RVD on ECMO associated with longer ECMO course, increased length of stay and trend toward increased mortality.
CLINICAL IMPLICATIONS: Understanding the tragectory of critially ill patients with RVD may help refine selection criteria for ECMO
DISCLOSURES: No relevant relationships by Karsten Bartels, source=Web Response
No relevant relationships by Sung-Min Cho, source=Web Response
No relevant relationships by Kathryn Colborn, source=Web Response
No relevant relationships by Kyle Enfield, source=Web Response
No relevant relationships by Eric Etchill, source=Web Response
No relevant relationships by Shoaib Fakhri, source=Web Response
No relevant relationships by Joseph Hippensteel, source=Web Response
No relevant relationships by Jordan Hoffman, source=Web Response
No relevant relationships by Sarah Jolley, source=Web Response
No relevant relationships by Alex Kadl, source=Web Response
No relevant relationships by Bo Kim, source=Web Response
No relevant relationships by Matthew Mart, source=Web Response
No relevant relationships by Kirby Mayer, source=Web Response
No relevant relationships by Ashley Montgomery-Yates, source=Web Response
No relevant relationships by Ann Parker, source=Web Response
No relevant relationships by CHINTAN RAMANI, source=Web Response
No relevant relationships by Jessica Rove, source=Web Response
No relevant relationships by Carla Sevin, source=Web Response
No relevant relationships by Lauren Taylor, source=Web Response
No relevant relationships by Nicholas Teman, source=Web Response
Advisory relationship with Avania Please note: 2020 to present Added 05/10/2021 by Glenn Whitman, source=Web Response, value=Consulting
Owner/Founder relationship with GWBN, llc Please note: 2019 Added 05/10/2021 by Glenn Whitman, source=Web Response, value=Ownership interest
no disclosure on file for Joseph Zwischenberger;