Right ventricular injury in patients with COVID-19-related ARDS eligible for ECMO support: a multicenter retrospective study
Abstract Background Coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) is associated with high mortality. Extracorporeal membrane oxygenation (ECMO) has been proposed in this setting, but optimal criteria to select target patients remain unknown. Our hypothesis is...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2024-03-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13613-024-01256-8 |
| _version_ | 1797233227262328832 |
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| author | Matthieu Petit Misylias Bouaoud Edouard Jullien Adrien Joseph Bruno Evrard Cyril Charron Anousone Daulasim Annick Legras Maeva Gourraud Marine Goudelin Philippe Vignon Antoine Vieillard-Baron |
| author_facet | Matthieu Petit Misylias Bouaoud Edouard Jullien Adrien Joseph Bruno Evrard Cyril Charron Anousone Daulasim Annick Legras Maeva Gourraud Marine Goudelin Philippe Vignon Antoine Vieillard-Baron |
| author_sort | Matthieu Petit |
| collection | DOAJ |
| description | Abstract Background Coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) is associated with high mortality. Extracorporeal membrane oxygenation (ECMO) has been proposed in this setting, but optimal criteria to select target patients remain unknown. Our hypothesis is that evaluation of right ventricular (RV) function could be helpful. The aims of our study were to report the incidence and outcomes of patients eligible for ECMO according to EOLIA criteria, and to identify a subgroup of patients with RV injury, which could be a target for ECMO. Methods Retrospective observational study involving 3 French intensive care units (ICUs) of teaching hospitals. Patients with confirmed SARS-CoV-2 infection between March 2020 and March 2021, presenting ARDS and with available echocardiography, were included. Patients were classified in three groups according to whether or not they met the EOLIA criteria and the presence of RV injury (RVI) (“EOLIA −”, “EOLIA + RVI −” and “EOLIA + RVI + ”). RVI was defined by the association of RV to left ventricular end-diastolic area ratio > 0.8 and paradoxical septal motion. Kaplan–Meier survival curves were used to analyze outcome as well as a Cox model for 90 day mortality. Results 915 patients were hospitalized for COVID-19, 418 of them with ARDS. A total of 283 patients with available echocardiography were included. Eighteen (6.3%) patients received ECMO. After exclusion of these patients, 107 (40.5%) were classified as EOLIA −, 126 (47.5%) as EOLIA + RVI −, and 32 (12%) as EOLIA + RVI + . Ninety-day mortality was 21% in the EOLIA-group, 44% in the EOLIA + RVI-group, and 66% in the EOLIA + RVI + group (p < 0.001). After adjustment, RVI was statistically associated with 90-day mortality (HR = 1.92 [1.10–3.37]). Conclusions Among COVID-19-associated ARDS patients who met the EOLIA criteria, those with significant RV pressure overload had a particularly poor outcome. This subgroup may be a more specific target for ECMO. This represented 12% of our cohort compared to 60% of patients who met the EOLIA criteria only. How the identification of this high-risk subset of patients translates into patient-centered outcomes remains to be evaluated. |
| first_indexed | 2024-04-24T16:12:49Z |
| format | Article |
| id | doaj.art-06bab08fcb144d5eab54c94c502d03ad |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-04-24T16:12:49Z |
| publishDate | 2024-03-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-06bab08fcb144d5eab54c94c502d03ad2024-03-31T11:35:25ZengSpringerOpenAnnals of Intensive Care2110-58202024-03-011411910.1186/s13613-024-01256-8Right ventricular injury in patients with COVID-19-related ARDS eligible for ECMO support: a multicenter retrospective studyMatthieu Petit0Misylias Bouaoud1Edouard Jullien2Adrien Joseph3Bruno Evrard4Cyril Charron5Anousone Daulasim6Annick Legras7Maeva Gourraud8Marine Goudelin9Philippe Vignon10Antoine Vieillard-Baron11Medical Intensive Care Unit, Ambroise Paré Hospital, APHPIntensive Care Unit, University Hospital of ToursMedical Intensive Care Unit, Ambroise Paré Hospital, APHPMedical Intensive Care Unit, Ambroise Paré Hospital, APHPMedical-Surgical Intensive Care Unit and Inserm CIC 1435, Dupuytren Teaching HospitalMedical Intensive Care Unit, Ambroise Paré Hospital, APHPMedical Intensive Care Unit, Ambroise Paré Hospital, APHPIntensive Care Unit, University Hospital of ToursIntensive Care Unit, University Hospital of ToursMedical-Surgical Intensive Care Unit and Inserm CIC 1435, Dupuytren Teaching HospitalMedical-Surgical Intensive Care Unit and Inserm CIC 1435, Dupuytren Teaching HospitalMedical Intensive Care Unit, Ambroise Paré Hospital, APHPAbstract Background Coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) is associated with high mortality. Extracorporeal membrane oxygenation (ECMO) has been proposed in this setting, but optimal criteria to select target patients remain unknown. Our hypothesis is that evaluation of right ventricular (RV) function could be helpful. The aims of our study were to report the incidence and outcomes of patients eligible for ECMO according to EOLIA criteria, and to identify a subgroup of patients with RV injury, which could be a target for ECMO. Methods Retrospective observational study involving 3 French intensive care units (ICUs) of teaching hospitals. Patients with confirmed SARS-CoV-2 infection between March 2020 and March 2021, presenting ARDS and with available echocardiography, were included. Patients were classified in three groups according to whether or not they met the EOLIA criteria and the presence of RV injury (RVI) (“EOLIA −”, “EOLIA + RVI −” and “EOLIA + RVI + ”). RVI was defined by the association of RV to left ventricular end-diastolic area ratio > 0.8 and paradoxical septal motion. Kaplan–Meier survival curves were used to analyze outcome as well as a Cox model for 90 day mortality. Results 915 patients were hospitalized for COVID-19, 418 of them with ARDS. A total of 283 patients with available echocardiography were included. Eighteen (6.3%) patients received ECMO. After exclusion of these patients, 107 (40.5%) were classified as EOLIA −, 126 (47.5%) as EOLIA + RVI −, and 32 (12%) as EOLIA + RVI + . Ninety-day mortality was 21% in the EOLIA-group, 44% in the EOLIA + RVI-group, and 66% in the EOLIA + RVI + group (p < 0.001). After adjustment, RVI was statistically associated with 90-day mortality (HR = 1.92 [1.10–3.37]). Conclusions Among COVID-19-associated ARDS patients who met the EOLIA criteria, those with significant RV pressure overload had a particularly poor outcome. This subgroup may be a more specific target for ECMO. This represented 12% of our cohort compared to 60% of patients who met the EOLIA criteria only. How the identification of this high-risk subset of patients translates into patient-centered outcomes remains to be evaluated.https://doi.org/10.1186/s13613-024-01256-8Acute respiratory distress syndromeCOVID-19Right ventricleExtracorporeal membrane oxygenation |
| spellingShingle | Matthieu Petit Misylias Bouaoud Edouard Jullien Adrien Joseph Bruno Evrard Cyril Charron Anousone Daulasim Annick Legras Maeva Gourraud Marine Goudelin Philippe Vignon Antoine Vieillard-Baron Right ventricular injury in patients with COVID-19-related ARDS eligible for ECMO support: a multicenter retrospective study Annals of Intensive Care Acute respiratory distress syndrome COVID-19 Right ventricle Extracorporeal membrane oxygenation |
| title | Right ventricular injury in patients with COVID-19-related ARDS eligible for ECMO support: a multicenter retrospective study |
| title_full | Right ventricular injury in patients with COVID-19-related ARDS eligible for ECMO support: a multicenter retrospective study |
| title_fullStr | Right ventricular injury in patients with COVID-19-related ARDS eligible for ECMO support: a multicenter retrospective study |
| title_full_unstemmed | Right ventricular injury in patients with COVID-19-related ARDS eligible for ECMO support: a multicenter retrospective study |
| title_short | Right ventricular injury in patients with COVID-19-related ARDS eligible for ECMO support: a multicenter retrospective study |
| title_sort | right ventricular injury in patients with covid 19 related ards eligible for ecmo support a multicenter retrospective study |
| topic | Acute respiratory distress syndrome COVID-19 Right ventricle Extracorporeal membrane oxygenation |
| url | https://doi.org/10.1186/s13613-024-01256-8 |
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