Faculty Collaboration Database

Extracorporeal Membrane Oxygenation with Right Ventricular Assist Device for COVID-19 ARDS. J Surg Res 2021 Aug;264:81-89

Date

04/01/2021

Pubmed ID

33789179

Pubmed Central ID

PMC7969863

DOI

10.1016/j.jss.2021.03.017

Scopus ID

2-s2.0-85103400526 (requires institutional sign-in at Scopus site)   42 Citations

Abstract

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.

Author List

Cain MT, Smith NJ, Barash M, Simpson P, Durham LA 3rd, Makker H, Roberts C, Falcucci O, Wang D, Walker R, Ahmed G, Brown SA, Nanchal RS, Joyce DL

Authors

Mark Barash DO Assistant Professor in the Medicine department at Medical College of Wisconsin
Lucian A. Durham MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin
Hemanckur Makker MD Assistant Professor in the Anesthesiology department at Medical College of Wisconsin
Rahul Sudhir Nanchal MD Professor in the Medicine department at Medical College of Wisconsin
Christopher J. Roberts MD, PhD Assistant Professor in the Anesthesiology department at Medical College of Wisconsin
Pippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin
Rebekah Walker PhD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Combined Modality Therapy
Critical Care
Extracorporeal Membrane Oxygenation
Female
Heart Failure
Heart-Assist Devices
Hospital Mortality
Humans
Intensive Care Units
Male
Middle Aged
Respiration, Artificial
Retrospective Studies
Severity of Illness Index
Treatment Outcome
Ventricular Dysfunction, Right