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

J Surg Res. 2021 Aug;264:81-89. doi: 10.1016/j.jss.2021.03.017. Epub 2021 Mar 18.

Abstract

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.

Keywords: Acute respiratory distress syndrome; COVID-19; Extracorporeal membrane oxygenation; Right ventricular assist device.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • COVID-19 / complications*
  • COVID-19 / diagnosis
  • COVID-19 / therapy
  • Combined Modality Therapy
  • Critical Care / methods
  • Critical Care / statistics & numerical data
  • Extracorporeal Membrane Oxygenation / methods*
  • Extracorporeal Membrane Oxygenation / statistics & numerical data
  • Female
  • Heart Failure / diagnosis
  • Heart Failure / etiology
  • Heart Failure / mortality
  • Heart Failure / therapy*
  • Heart-Assist Devices*
  • Hospital Mortality
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Male
  • Middle Aged
  • Respiration, Artificial / statistics & numerical data
  • Respiratory Distress Syndrome / diagnosis
  • Respiratory Distress Syndrome / etiology
  • Respiratory Distress Syndrome / mortality
  • Respiratory Distress Syndrome / therapy*
  • Retrospective Studies
  • Severity of Illness Index
  • Treatment Outcome
  • Ventricular Dysfunction, Right / diagnosis
  • Ventricular Dysfunction, Right / etiology
  • Ventricular Dysfunction, Right / mortality
  • Ventricular Dysfunction, Right / therapy*