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Extracorporeal Membrane Oxygenation with Right Ventricular Assist Device for COVID-19 ARDS

Background: Right ventricular failure is an underrecognized consequence of COVID-19 pneumonia. Those with severe disease are treated with extracorporeal membrane oxygenation (ECMO) but with poor outcomes. Concomitant right ventricular assist device (RVAD) may be beneficial. Methods: A retrospective...

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Autores principales: Cain, Michael T., Smith, Nathan J., Barash, Mark, Simpson, Pippa, Durham, Lucian A., Makker, Hemanckur, Roberts, Christopher, Falcucci, Octavio, Wang, Dong, Walker, Rebekah, Ahmed, Gulrayz, Brown, Sherry-Ann, Nanchal, Rahul S., Joyce, David L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969863/
https://www.ncbi.nlm.nih.gov/pubmed/33789179
http://dx.doi.org/10.1016/j.jss.2021.03.017
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author Cain, Michael T.
Smith, Nathan J.
Barash, Mark
Simpson, Pippa
Durham, Lucian A.
Makker, Hemanckur
Roberts, Christopher
Falcucci, Octavio
Wang, Dong
Walker, Rebekah
Ahmed, Gulrayz
Brown, Sherry-Ann
Nanchal, Rahul S.
Joyce, David L.
author_facet Cain, Michael T.
Smith, Nathan J.
Barash, Mark
Simpson, Pippa
Durham, Lucian A.
Makker, Hemanckur
Roberts, Christopher
Falcucci, Octavio
Wang, Dong
Walker, Rebekah
Ahmed, Gulrayz
Brown, Sherry-Ann
Nanchal, Rahul S.
Joyce, David L.
author_sort Cain, Michael T.
collection PubMed
description Background: Right ventricular failure is an underrecognized consequence of COVID-19 pneumonia. Those with severe disease are treated with extracorporeal membrane oxygenation (ECMO) but with poor outcomes. Concomitant right ventricular assist device (RVAD) may be beneficial. Methods: A retrospective analysis of intensive care unit patients admitted with COVID-19 ARDS (Acute Respiratory Distress Syndrome) was performed. Nonintubated patients, those with acute kidney injury, and age > 75 were excluded. Patients who underwent RVAD/ECMO support were compared with those managed via invasive mechanical ventilation (IMV) alone. The primary outcome was in-hospital mortality. Secondary outcomes included 30-d mortality, acute kidney injury, length of ICU stay, and duration of mechanical ventilation. Results: A total of 145 patients were admitted to the ICU with COVID-19. Thirty-nine patients met inclusion criteria. Of these, 21 received IMV, and 18 received RVAD/ECMO. In-hospital (52.4 versus 11.1%, P = 0.008) and 30-d mortality (42.9 versus 5.6%, P= 0.011) were significantly lower in patients treated with RVAD/ECMO. Acute kidney injury occurred in 15 (71.4%) patients in the IMV group and zero RVAD/ECMO patients (P< 0.001). ICU (11.5 versus 21 d, P= 0.067) and hospital (14 versus 25.5 d, P = 0.054) length of stay were not significantly different. There were no RVAD/ECMO device complications. The duration of mechanical ventilation was not significantly different (10 versus 5 d, P = 0.44). Conclusions: RVAD support at the time of ECMO initiation resulted in the no secondary end-organ damage and higher in-hospital and 30-d survival versus IMV in specially selected patients with severe COVID-19 ARDS. Management of severe COVID-19 ARDS should prioritize right ventricular support.
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spelling pubmed-79698632021-03-18 Extracorporeal Membrane Oxygenation with Right Ventricular Assist Device for COVID-19 ARDS Cain, Michael T. Smith, Nathan J. Barash, Mark Simpson, Pippa Durham, Lucian A. Makker, Hemanckur Roberts, Christopher Falcucci, Octavio Wang, Dong Walker, Rebekah Ahmed, Gulrayz Brown, Sherry-Ann Nanchal, Rahul S. Joyce, David L. J Surg Res Association for Academic Surgery Background: Right ventricular failure is an underrecognized consequence of COVID-19 pneumonia. Those with severe disease are treated with extracorporeal membrane oxygenation (ECMO) but with poor outcomes. Concomitant right ventricular assist device (RVAD) may be beneficial. Methods: A retrospective analysis of intensive care unit patients admitted with COVID-19 ARDS (Acute Respiratory Distress Syndrome) was performed. Nonintubated patients, those with acute kidney injury, and age > 75 were excluded. Patients who underwent RVAD/ECMO support were compared with those managed via invasive mechanical ventilation (IMV) alone. The primary outcome was in-hospital mortality. Secondary outcomes included 30-d mortality, acute kidney injury, length of ICU stay, and duration of mechanical ventilation. Results: A total of 145 patients were admitted to the ICU with COVID-19. Thirty-nine patients met inclusion criteria. Of these, 21 received IMV, and 18 received RVAD/ECMO. In-hospital (52.4 versus 11.1%, P = 0.008) and 30-d mortality (42.9 versus 5.6%, P= 0.011) were significantly lower in patients treated with RVAD/ECMO. Acute kidney injury occurred in 15 (71.4%) patients in the IMV group and zero RVAD/ECMO patients (P< 0.001). ICU (11.5 versus 21 d, P= 0.067) and hospital (14 versus 25.5 d, P = 0.054) length of stay were not significantly different. There were no RVAD/ECMO device complications. The duration of mechanical ventilation was not significantly different (10 versus 5 d, P = 0.44). Conclusions: RVAD support at the time of ECMO initiation resulted in the no secondary end-organ damage and higher in-hospital and 30-d survival versus IMV in specially selected patients with severe COVID-19 ARDS. Management of severe COVID-19 ARDS should prioritize right ventricular support. Elsevier Inc. 2021-08 2021-03-18 /pmc/articles/PMC7969863/ /pubmed/33789179 http://dx.doi.org/10.1016/j.jss.2021.03.017 Text en © 2021 Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Association for Academic Surgery
Cain, Michael T.
Smith, Nathan J.
Barash, Mark
Simpson, Pippa
Durham, Lucian A.
Makker, Hemanckur
Roberts, Christopher
Falcucci, Octavio
Wang, Dong
Walker, Rebekah
Ahmed, Gulrayz
Brown, Sherry-Ann
Nanchal, Rahul S.
Joyce, David L.
Extracorporeal Membrane Oxygenation with Right Ventricular Assist Device for COVID-19 ARDS
title Extracorporeal Membrane Oxygenation with Right Ventricular Assist Device for COVID-19 ARDS
title_full Extracorporeal Membrane Oxygenation with Right Ventricular Assist Device for COVID-19 ARDS
title_fullStr Extracorporeal Membrane Oxygenation with Right Ventricular Assist Device for COVID-19 ARDS
title_full_unstemmed Extracorporeal Membrane Oxygenation with Right Ventricular Assist Device for COVID-19 ARDS
title_short Extracorporeal Membrane Oxygenation with Right Ventricular Assist Device for COVID-19 ARDS
title_sort extracorporeal membrane oxygenation with right ventricular assist device for covid-19 ards
topic Association for Academic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969863/
https://www.ncbi.nlm.nih.gov/pubmed/33789179
http://dx.doi.org/10.1016/j.jss.2021.03.017
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