Prognostic value of respiratory compliance course on mortality in COVID-19 patients with vv-ECMO
Abstract Background COVID-19-associated acute respiratory distress syndrome (ARDS) supported by veno-venous extra-corporal membrane oxygenation (vv-ECMO) results in a high in-hospital mortality rate of more than 35%. However, after cannulation, no prognostic factor has been described to guide the ma...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-06-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13613-023-01152-7 |
| _version_ | 1797795541923397632 |
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| author | Simon Valentin Mathieu Amalric Guillaume Granier Benjamin Pequignot Christophe Guervilly Kevin Duarte Nicolas Girerd Bruno Levy Paul Dunand Matthieu Koszutski Hadrien Roze Antoine Kimmoun |
| author_facet | Simon Valentin Mathieu Amalric Guillaume Granier Benjamin Pequignot Christophe Guervilly Kevin Duarte Nicolas Girerd Bruno Levy Paul Dunand Matthieu Koszutski Hadrien Roze Antoine Kimmoun |
| author_sort | Simon Valentin |
| collection | DOAJ |
| description | Abstract Background COVID-19-associated acute respiratory distress syndrome (ARDS) supported by veno-venous extra-corporal membrane oxygenation (vv-ECMO) results in a high in-hospital mortality rate of more than 35%. However, after cannulation, no prognostic factor has been described to guide the management of these patients. The objective was to assess the association between static respiratory compliance over the first 10 days post-vv-ECMO implantation on 180-day mortality. Results In this multicentric retrospective study in three ECMO referral centers, all patients with COVID-19-associated ARDS supported by vv-ECMO were included from 03/01/2020 to 12/31/2021. Patients were ventilated with ultra-protective settings targeting a driving pressure lower than 15 cmH2O. 122 patients were included. Median age was 59 IQR (52–64), 83 (68%) were male, with a median body mass index of 33 (28–37) kg/m2. Delay between first symptoms to vv-ECMO implantation was 16 (10–21) days. Six-month death was 48%. Over the first ten days, compliance increased in 180 day survivors [from 18 (12–25) to 20 (15–27) mL/cmH2O] compared to non-survivors [from 12 (9–20) to 10 (8–14) mL/cmH2O, p interaction < 0.0001]. A time varying multivariable Cox model found age, history of chronic lung disease, compliance from day one to day ten and sweep gas flow from day one to day ten as independent factors associated with 180-day mortality. Conclusions In COVID-19-associated ARDS, static respiratory compliance course over the first ten days post-vv-ECMO implantation is associated with 180-day mortality. This new information may provide crucial information on the patient's prognosis for intensivists. |
| first_indexed | 2024-03-13T03:19:32Z |
| format | Article |
| id | doaj.art-cdecef76ecde46d19cd7490a93cad5a1 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-03-13T03:19:32Z |
| publishDate | 2023-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-cdecef76ecde46d19cd7490a93cad5a12023-06-25T11:27:28ZengSpringerOpenAnnals of Intensive Care2110-58202023-06-0113111110.1186/s13613-023-01152-7Prognostic value of respiratory compliance course on mortality in COVID-19 patients with vv-ECMOSimon Valentin0Mathieu Amalric1Guillaume Granier2Benjamin Pequignot3Christophe Guervilly4Kevin Duarte5Nicolas Girerd6Bruno Levy7Paul Dunand8Matthieu Koszutski9Hadrien Roze10Antoine Kimmoun11CHRU de Nancy, Médecine Intensive et Réanimation Brabois, Université de LorraineMédecine Intensive et Réanimation, Hôpital Nord, Assistance Publique - Hôpitaux de MarseilleCHRU de Nancy, Médecine Intensive et Réanimation Brabois, Université de LorraineCHRU de Nancy, Médecine Intensive et Réanimation Brabois, Université de LorraineMédecine Intensive et Réanimation, Hôpital Nord, Assistance Publique - Hôpitaux de MarseilleINSERM 1433 CIC-P CHRU de Nancy, FCRIN INI-CRCT, Université de LorraineINSERM 1433 CIC-P CHRU de Nancy, FCRIN INI-CRCT, Université de LorraineCHRU de Nancy, Médecine Intensive et Réanimation Brabois, Université de LorraineCHRU de Nancy, Médecine Intensive et Réanimation Brabois, Université de LorraineCHRU de Nancy, Médecine Intensive et Réanimation Brabois, Université de LorraineDépartement d’anesthésie Réanimation Sud, Centre Médico-Chirurgical Magellan, Hôpital, Haut Leveque Hospital, Université de BordeauxCHRU de Nancy, Médecine Intensive et Réanimation Brabois, Université de LorraineAbstract Background COVID-19-associated acute respiratory distress syndrome (ARDS) supported by veno-venous extra-corporal membrane oxygenation (vv-ECMO) results in a high in-hospital mortality rate of more than 35%. However, after cannulation, no prognostic factor has been described to guide the management of these patients. The objective was to assess the association between static respiratory compliance over the first 10 days post-vv-ECMO implantation on 180-day mortality. Results In this multicentric retrospective study in three ECMO referral centers, all patients with COVID-19-associated ARDS supported by vv-ECMO were included from 03/01/2020 to 12/31/2021. Patients were ventilated with ultra-protective settings targeting a driving pressure lower than 15 cmH2O. 122 patients were included. Median age was 59 IQR (52–64), 83 (68%) were male, with a median body mass index of 33 (28–37) kg/m2. Delay between first symptoms to vv-ECMO implantation was 16 (10–21) days. Six-month death was 48%. Over the first ten days, compliance increased in 180 day survivors [from 18 (12–25) to 20 (15–27) mL/cmH2O] compared to non-survivors [from 12 (9–20) to 10 (8–14) mL/cmH2O, p interaction < 0.0001]. A time varying multivariable Cox model found age, history of chronic lung disease, compliance from day one to day ten and sweep gas flow from day one to day ten as independent factors associated with 180-day mortality. Conclusions In COVID-19-associated ARDS, static respiratory compliance course over the first ten days post-vv-ECMO implantation is associated with 180-day mortality. This new information may provide crucial information on the patient's prognosis for intensivists.https://doi.org/10.1186/s13613-023-01152-7ComplianceCOVID-19ECMORespiratory distress syndrome |
| spellingShingle | Simon Valentin Mathieu Amalric Guillaume Granier Benjamin Pequignot Christophe Guervilly Kevin Duarte Nicolas Girerd Bruno Levy Paul Dunand Matthieu Koszutski Hadrien Roze Antoine Kimmoun Prognostic value of respiratory compliance course on mortality in COVID-19 patients with vv-ECMO Annals of Intensive Care Compliance COVID-19 ECMO Respiratory distress syndrome |
| title | Prognostic value of respiratory compliance course on mortality in COVID-19 patients with vv-ECMO |
| title_full | Prognostic value of respiratory compliance course on mortality in COVID-19 patients with vv-ECMO |
| title_fullStr | Prognostic value of respiratory compliance course on mortality in COVID-19 patients with vv-ECMO |
| title_full_unstemmed | Prognostic value of respiratory compliance course on mortality in COVID-19 patients with vv-ECMO |
| title_short | Prognostic value of respiratory compliance course on mortality in COVID-19 patients with vv-ECMO |
| title_sort | prognostic value of respiratory compliance course on mortality in covid 19 patients with vv ecmo |
| topic | Compliance COVID-19 ECMO Respiratory distress syndrome |
| url | https://doi.org/10.1186/s13613-023-01152-7 |
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