• J. Cardiothorac. Vasc. Anesth. · Dec 2024

    Echocardiographic Findings in Critically Ill COVID-19 Patients Treated With and Without Extracorporeal Membrane Oxygenation.

    • Diana Morales Castro, Bruno L Ferreyro, David McAlpine, Nikolaos Evangelatos, Laura Dragoi, Ricardo Teijeiro-Paradis, Lorenzo Del Sorbo, Eddy Fan, and Ghislaine Douflé.
    • Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: diana.moralescastro@uhn.ca.
    • J. Cardiothorac. Vasc. Anesth. 2024 Dec 1; 38 (12): 304330543043-3054.

    ObjectivesTo describe echocardiographic findings among mechanically ventilated patients with COVID-19 acute respiratory distress syndrome, comparing those with and without venovenous extracorporeal membrane oxygenation (VV ECMO) support.DesignSingle-center, retrospective cohort study.SettingIntensive care unit (ICU) of a quaternary academic center.ParticipantsPatients with COVID-19 admitted between March 2020 and June 2021 receiving mechanical ventilation, with an echocardiogram within 72 hours of admission.InterventionsAdmission and follow-up echocardiograms during ICU stay.MeasurementsPatient characteristics and echocardiographic findings were analyzed. Mortality odds ratio (OR) for right ventricular (RV) systolic dysfunction and acute cor pulmonale (ACP) was calculated.Main ResultsAmong 242 patients, 145 (60%) received VV ECMO. Median (IQR) PaO2/FiO2 was 76 (65-95) and 98 (85-140) in ECMO and non-ECMO patients, respectively (p ≤ 0.001). Initial echocardiograms showed no significant differences in left ventricular systolic dysfunction (10% v 15 %, p = 0.31) and RV systolic dysfunction (38% v. 27%, p = 0.27) between ECMO and non-ECMO patients. ACP was more frequent in the ECMO group at baseline (41% v. 26 %, p = 0.02). During the ICU stay, patients on ECMO exhibited a higher prevalence of RV systolic dysfunction (55% v 34%, p = 0.001) and ACP (51% v 26%, p = 0.002). RV systolic dysfunction (OR 1.99; 95% CI 1.09-3.63) and ACP (OR 2.95; 95% CI 1.55-5.62) on the follow-up echocardiograms were associated with higher odds of ICU mortality.ConclusionsThe prevalence of echocardiographic abnormalities, in particular RV dysfunction, was frequent among patients with COVID-19 receiving VV ECMO support and was associated with worse clinical outcomes.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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