Right Ventricular Dysfunction is Associated with Increased Mortality in Patients Requiring Venovenous Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019

Abstract

Respiratory failure caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is associated with mortality. Patients unresponsive to conventional therapy may benefit from temporary venovenous extracorporeal membrane oxygenation (VV-ECMO). We investigated clinical and echocardiographic characteristics, particularly, right ventricular dysfunction, with survival in patients with respiratory failure caused by SARS-CoV-2. We performed a single-center retrospective cohort study of patients requiring VV-ECMO for respiratory failure from COVID-19 infection between January 2020 and December 2020. Demographics, comorbidities, laboratory parameters, and echocardiographic features of left and right ventricular (LV/RV) function were compared between patients who survived and those who could not be weaned from VV-ECMO. In addition, we evaluated outcomes in a separate population managed with venoarterial extracorporeal membrane oxygenation (VA-ECMO). In total, 10/17 patients failed to wean from VV-ECMO and died in the hospital on average 41.5 ± 10.9 days post admission. Seven were decannulated (41%) and survived to hospital discharge. There were no significant differences in demographics, comorbidities, and laboratory parameters between groups. Moderate to severe RV dysfunction was significantly more in those who died (8/10, 80%) compared to survivors (0/7, 0%) (p = 0.002). Patients supported with VA-ECMO had superior survival with 5/9 patients (56%) decannulated and discharged. Moderate to severe RV dysfunction is associated with increased mortality in patients with respiratory failure requiring VV-ECMO for COVID-19.

Outcomes of Veno-Venous Extracorporeal Membrane Oxygenation in Patients with Severe Acute Respiratory Distress Syndrome (ARDS) Infected with SARS-nCoV2 infection.

“…Prolonged mechanical ventilation beyond 6.5 days and initiation of ECMO in patients on mechanical ventilation beyond 07 days have shown poor outcomes (9). Acute right ventricular dysfunction before initiation of ECMO was also shown to have a worse outcome with increased mortality, which was present in 4 (50%) patients in our series (10). VV ECMO allows ultralow lung-protective ventilation thereby preventing barotrauma, that is, pneumothorax and pneumomediastinum, volutrauma, and atelectotrauma (11,12).…”

Right Ventricular Injury Increases Mortality in Patients with Acute Respiratory Distress Syndrome on Veno-Venous Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis

“…Seven studies were included in the final analysis, which included 452 patients (Table 1). 20–22,24–26,28…”

“…20,25,26 Four studies incorporated measures of RV dilatation into their definition, 22,24,26,28 three studies included tricuspid annular plane systolic excursion 21,22,24 and two studies included RV fractional area change % to define RVI. 20,22…”

“…Seven studies were included in the final analysis, which included 452 patients (Table 1). [20][21][22][24][25][26]28 The summary characteristics of the seven included studies are given in Table 1. Included data spans from September 2009 to February 2021.…”

“…RVI definitions varied, with three studies using a single measurement to define RVI. 20,25,26 Four studies incorporated measures of RV dilatation into their definition, 22,24,26,28 three studies included tricuspid annular plane systolic excursion 21,22,24 and two studies included RV fractional area change % to define RVI. 20,22 Outcomes For our primary outcome, the overall mortality from the 452 included patients in the primary analysis was 35% (Table 2).…”