Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Apr 26, 2023; 15(4): 165-173
Published online Apr 26, 2023. doi: 10.4330/wjc.v15.i4.165
Right ventricle dysfunction does not predict mortality in patients with SARS-CoV-2-related acute respiratory distress syndrome on extracorporeal membrane oxygenation support
Chiara Lazzeri, Manuela Bonizzoli, Stefano Batacchi, Giovanni Cianchi, Andrea Franci, Filippo Socci, Marco Chiostri, Adriano Peris
Chiara Lazzeri, Manuela Bonizzoli, Stefano Batacchi, Giovanni Cianchi, Andrea Franci, Filippo Socci, Marco Chiostri, Adriano Peris, ICU and ECMO Center, Florence 50134, Italy
Author contributions: Lazzeri C was the guarantor and designed the study; Batacchi S, Cianchi G, Franci A and Socci F participated in the acquisition, analysis, and interpretation of data; Bonizzoli M, Chiostri M and Peris A drafted the initial manuscript; and all authors revised the article critically for important intellectual content.
Institutional review board statement: The study protocol was approved by our Ethical Committee (“Comitato Etico Area Vasta Centro” n.17024, approved on March 31th 2020) (“Florence COVID ICU Registry”).
Informed consent statement: Patient’s consent was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No data sharing.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chiara Lazzeri, MD, Chief Physician, Senior Researcher, ICU and ECMO Center, Largo brambilla 3, Florence 50134, Italy. lazzeri.ch@gmail.com
Received: November 19, 2022
Peer-review started: November 19, 2022
First decision: December 13, 2022
Revised: December 15, 2022
Accepted: March 17, 2023
Article in press: March 17, 2023
Published online: April 26, 2023
Processing time: 151 Days and 16.4 Hours
Abstract
BACKGROUND

The prognostic role of right ventricle dilatation and dysfunction (RVDD) has not been elucidated in patients with coronavirus disease (COVID)-related respiratory failure refractory to standard treatment needing extracorporeal membrane oxygenation (ECMO) support.

AIM

To assess whether pre veno-venous (VV) ECMO RVDD were related to in-intensive care unit (ICU) mortality.

METHODS

We enrolled 61 patients with COVID-related acute respiratory distress syndrome refractory to conventional treatment submitted to VV ECMO and consecutively admitted to our ICU (an ECMO referral center) from 31th March 2020 to 31th August 2021. An echocardiographic exam was performed immediately before VV ECMO implantation.

RESULTS

Males were prevalent (73.8%) and patients with a body mass index > 30 kg/m2 were the majority (46/61, 75%). The overall in-ICU mortality rate was 54.1% (33/61). RVDD was detectable in more than half of the population (34/61, 55.7%) and associated with higher simplified organ functional assessment (SOFA) values (P = 0.029) and a longer mechanical ventilation duration prior to ECMO support (P = 0.046). Renal replacement therapy was more frequently needed in RVDD patients (P = 0.002). A higher in-ICU mortality (P = 0.024) was observed in RVDD patients. No echo variables were independent predictors of in-ICU death.

CONCLUSION

In patients with COVID-related respiratory failure on ECMO support, RVDD (dilatation and dysfunction) is a common finding and identifies a subset of patients characterized by a more severe disease (as indicated by higher SOFA values and need of renal replacement therapy) and by a higher in-ICU mortality. RVDD (also when considered separately) did not result independently associated with in-ICU mortality in these patients.

Keywords: Right ventricle; Echocardiography; Mortality; COVID; Acute respiratory distress syndrome; Right ventricle-pulmonary circulation coupling

Core Tip: In coronavirus disease-related respiratory failure on extracorporeal membrane oxygenation support right ventricle dilatation and dysfunction (defined as the coexistence of dilatation and dysfunction) is a common finding and identifies a subset of patients characterized by a more severe disease (as indicated by higher Sequential Organ Failure Assessment values and need of renal replacement therapy) and by a higher in-intensive care unit (ICU) mortality. However, at logistic regression analysis, right ventricle dilatation and dysfunction (even when considered separately) did not result independently associated with in-ICU mortality in these patients.