Worse survival in patients with right ventricular dysfunction and COVID-19–associated acute respiratory distress requiring extracorporeal membrane oxygenation: A multicenter study from the ORACLE Group

Cain, Michael T.; Taylor, Lauren J.; Colborn, Kathryn; Teman, Nicholas R.; Hoffman, Jordan; Mayer, Kirby P.; Etchill, Eric; Sevin, Carla M.; Jaishankar, Sruthi; Ramanan, Raj; Enfield, Kyle B.; Zwischenberger, Joseph B.; Jolley, Sarah E.; Rove, Jessica Y.

doi:10.1016/j.jtcvs.2022.12.013

Cited by 4 publications

(1 citation statement)

References 36 publications

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“…All studies were single-center retrospective observational studies, except for one that was multi-center retrospective observational in nature [12]. The sample sizes ranged from six to 219 subjects.…”

Section: Characteristics Of Sources Of Evidencementioning

confidence: 99%

Right ventricular injury definition and management in patients with severe respiratory failure receiving veno-venous extracorporeal membrane oxygenation: a scoping review

Dugar,

Sato,

Charlton

et al. 2024

Preprint

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Purpose: Right ventricular (RV) injury in patients with respiratory failure receiving veno-venous extracorporeal membrane oxygenation (VV ECMO) is associated with significant mortality. A consensus on the definition and management of RV injury in patients receiving VV ECMO is currently lacking. Therefore, a scoping review is necessary to map the current literature and guide future research regarding the definition and management of RV injury in patients receiving VV ECMO. Methods: Using a robust scoping review methodology, we searched for relevant publications on RV injury in patients receiving VV ECMO in Medline, EMBASE, and Web of Science. Two authors extracted the data independently and in duplicate. Results: Of 1,868 citations screened, 30 studies reporting on RV injury during VV ECMO were identified. Of those, twenty-three studies reported on the definition of RV injury including echocardiographic indices of RV function and dimensions (tricuspid annular plane systolic excursion or right to left ventricular end-diastolic area ratio, respectively). Thirteen studies reported on the management of RV injury, including veno-pulmonary (VP) ECMO, veno-arterial (VA) ECMO, positive inotropic agents, pulmonary vasodilators, ultra-lung-protective ventilation, and optimization of positive end-expiratory pressure. Conclusion: The definitions of RV injury in patients receiving VV ECMO used in the literature are heterogeneous. Despite the high incidence of RV injury during VV ECMO support and its strong association with mortality, studies investigating therapeutic strategies for RV injury are lacking. To fill the existing knowledge gaps, a consensus on the definition of RV injury and research investigating RV-targeted therapies during VV ECMO are urgently warranted. Trial Registration The search protocol was registered in the Open Science Framework (https://osf.io/e2km6).

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Section: Characteristics Of Sources Of Evidencementioning

confidence: 99%

Right ventricular injury definition and management in patients with severe respiratory failure receiving veno-venous extracorporeal membrane oxygenation: a scoping review

Dugar,

Sato,

Charlton

et al. 2024

Preprint

View full text Add to dashboard Cite

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Commentary: Extreme cardiorespiratory pathophysiology: Critical care evolution in response to a pandemic

Dimarakis

Aldea

2023

The Journal of Thoracic and Cardiovascular Surgery

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Right ventricular injury in patients with COVID-19-related ARDS eligible for ECMO support: a multicenter retrospective study

Petit,

Bouaoud,

Jullien

et al. 2024

Ann. Intensive Care

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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.

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Worse survival in patients with right ventricular dysfunction and COVID-19–associated acute respiratory distress requiring extracorporeal membrane oxygenation: A multicenter study from the ORACLE Group

Cited by 4 publications

References 36 publications

Right ventricular injury definition and management in patients with severe respiratory failure receiving veno-venous extracorporeal membrane oxygenation: a scoping review

Right ventricular injury definition and management in patients with severe respiratory failure receiving veno-venous extracorporeal membrane oxygenation: a scoping review

Commentary: Extreme cardiorespiratory pathophysiology: Critical care evolution in response to a pandemic

Right ventricular injury in patients with COVID-19-related ARDS eligible for ECMO support: a multicenter retrospective study

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