Right Ventricular Dysfunction Is Associated With Increased Mortality In Patients Requiring Veno-venous Extracorporeal Membrane Oxygenation For The Management Of Severe Respiratory Failure In Covid-19 Infection

PURPOSE: Refractory respiratory failure caused by the coronavirus SARS-CoV-2 is associated with a significant mortality rate. Patients unresponsive to conventional medical therapy may benefit from temporary veno-venous extracorporeal membrane oxygenation (VV-ECMO), which provides complete gas exchange while allowing the patient to recover. We sought to investigate the role of right ventricular failure in the outcomes of these patients since clinical and echocardiographic characteristics that predict survival are not yet defined in patients with respiratory failure caused by SARS-CoV-2. METHODS: We performed a single center retrospective cohort study enrolling consecutive patients that required VV-ECMO for the management of refractory respiratory failure between January and December 2020. Seventeen consecutive patients with COVID-19 infection were included in the reported cohort. 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 and died. RESULTS: Ten of the 17 patients failed to wean from VV-ECMO and died in the hospital on average 41.5 ± 10.9 days post admission. Seven were successfully decannulated and survived to hospital discharge on average 39.0 ± 19.8 days after admission. There were no significant differences in demographics, comorbidities, laboratory parameters between the groups. LV size and function were also similar. However, moderate to severe RV dysfunction was significantly more frequent in the group of patients who died (8/10, 80%) compared to the survivors (0/7, 0%) (p=0.0017). CONCLUSION: Severe RV dysfunction is associated with increased mortality among patients with severe COVID-19 associated respiratory failure treated with VV-ECMO. Measures to support RV function, including temporary mechanical RV support devices, should be considered for these patients aiming to improve survival.