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.
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.
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DOI：
10.1016/j.jtcvs.2022.12.013
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发表时间：
2024-05
影响因子：
6
通讯作者：
Rove, Jessica Y.
中科院分区：
文献类型：
--
作者：
Cain, Michael T.;Taylor, Lauren J.;Colborn, Kathryn;Teman, Nicholas R.;Hoffman, Jordan;Mayer, Kirby P.;Etchill, Eric W.;Sevin, Carla M.;Jaishankar, Sruthi;Ramanan, Raj;Enfield, Kyle;Zwischenberger, Joseph B.;Jolley, Sarah E.;Rove, Jessica Y.
我们试图确定右室功能障碍对需要静脉-静脉体外膜氧合的机械通气COVID-19患者预后的影响。6个学术中心对第一波疫情期间（2020年3月至8月）采用静脉-静脉体外膜氧合分层机械通气的COVID-19患者进行了回顾性分析。超声心动图表现的临床适应症回顾了左、右心室功能。比较基线特征、住院特征和生存率。该队列纳入424例机械通气的COVID-19患者，其中126例接受静脉-静脉体外膜氧合。超声心动图显示，接受体外膜氧合的患者中有38.1%出现右室功能障碍，未接受体外膜氧合的患者中有27.4%出现右室功能障碍。接受体外膜氧合的患者中有5.5%出现双心室功能障碍。体外膜氧合组和非体外膜氧合组的基线患者特征相似，按存在右室功能障碍分层。在体外膜氧合队列中，右室功能障碍与正性肌力使用增加（66.7% vs 24.4%, P < 0.001）、出血并发症（77.1% vs 53.8%, P = 0.015）和独立于左室功能障碍的较差生存率（39.6% vs 64.1%, P = 0.012）相关。在体外膜氧合前的通气天数、住院时间、体外膜氧合时间、机械通气时间、血管加压剂使用、吸入式肺血管扩张剂使用、感染并发症、凝血并发症或卒中方面无显著差异。没有体外膜氧合的队列在住院结果上没有统计学上的显著差异。经静脉-静脉体外膜氧合支持的covid -19相关急性呼吸窘迫综合征患者存在右室功能障碍与院内死亡率增加相关。需要进一步的研究来确定减轻需要静脉-静脉体外膜氧合的患者的右心室功能障碍是否能提高死亡率。
We sought to determine the impact of right ventricular dysfunction on the outcomes of mechanically ventilated patients with COVID-19 requiring veno-venous extracorporeal membrane oxygenation. Six academic centers conducted a retrospective analysis of mechanically ventilated patients with COVID-19 stratified by support with veno-venous extracorporeal membrane oxygenation during the first wave of the pandemic (March to August 2020). Echocardiograms performed for clinical indications were reviewed for right and left ventricular function. Baseline characteristics, hospitalization characteristics, and survival were compared. The cohort included 424 mechanically ventilated patients with COVID-19, 126 of whom were cannulated for veno-venous extracorporeal membrane oxygenation. Right ventricular dysfunction was observed in 38.1% of patients who received extracorporeal membrane oxygenation and 27.4% of patients who did not receive extracorporeal membrane oxygenation with an echocardiogram. Biventricular dysfunction was observed in 5.5% of patients who received extracorporeal membrane oxygenation. Baseline patient characteristics were similar in both the extracorporeal membrane oxygenation and non–extracorporeal membrane oxygenation cohorts stratified by the presence of right ventricular dysfunction. In the extracorporeal membrane oxygenation cohort, right ventricular dysfunction was associated with increased inotrope use (66.7% vs 24.4%, P < .001), bleeding complications (77.1% vs 53.8%, P = .015), and worse survival independent of left ventricular dysfunction (39.6% vs 64.1%, P = .012). There was no significant difference in days ventilated before extracorporeal membrane oxygenation, length of hospital stay, hours on extracorporeal membrane oxygenation, duration of mechanical ventilation, vasopressor use, inhaled pulmonary vasodilator use, infectious complications, clotting complications, or stroke. The cohort without extracorporeal membrane oxygenation cohort demonstrated no statistically significant differences in in-hospital outcomes. The presence of right ventricular dysfunction in patients with COVID-19–related acute respiratory distress syndrome supported with veno-venous extracorporeal membrane oxygenation was associated with increased in-hospital mortality. Additional studies are required to determine if mitigating right ventricular dysfunction in patients requiring veno-venous extracorporeal membrane oxygenation improves mortality.
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影响因子：
38.9
作者：
Boissier, Florence;Katsahian, Sandrine;Dessap, Armand Mekontso
通讯作者：
Dessap, Armand Mekontso
影响因子：
4.2
作者：
Badu, Bernice;Cain, Michael T.;Joyce, David L.
通讯作者：
Joyce, David L.
DOI：
10.1016/j.hrtlng.2021.12.007
发表时间：
2022-03
期刊：
Heart & lung : the journal of critical care
影响因子：
--
作者：
Díaz JJS;Rincon JM;López MAR;Zuleta MB;Castellanos N;Saavedra ZS;Rodríguez HC;Barrera DFH;Parra JE;Fernández JJD
通讯作者：
Fernández JJD
DOI：
10.1016/s0140-6736(20)32008-0
发表时间：
2020-10-10
期刊：
Lancet (London, England)
影响因子：
--
作者：
Barbaro RP;MacLaren G;Boonstra PS;Iwashyna TJ;Slutsky AS;Fan E;Bartlett RH;Tonna JE;Hyslop R;Fanning JJ;Rycus PT;Hyer SJ;Anders MM;Agerstrand CL;Hryniewicz K;Diaz R;Lorusso R;Combes A;Brodie D;Extracorporeal Life Support Organization
通讯作者：
Extracorporeal Life Support Organization
影响因子：
24
作者：
Inciardi, Riccardo M.;Lupi, Laura;Metra, Marco
通讯作者：
Metra, Marco