PERSISTENT RIGHT VENTRICLE DILATATION IN SARS-COV2-related ACUTE RESPIRATORY DISTRESS SYNDROME ON EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT

Lazzeri, Chiara; Bonizzoli, Manuela; Batacchi, Stefano; Cianchi, Giovanni; Franci, Andrea; Socci, Filippo; Peris, Adriano

OBJECTIVE(S): Design; Setting; Participants; Interventions; Measurements & Main Results; Conclusions. OBJECTIVES: Veno-venous extracorporeal membrane oxygenation (ECMO) support may be considered in experienced centers for patients with Acute Respiratory Distress Syndrome (ARDS) due to SARS-CoV2 infection (COVID) refractory to conventional treatment. In ECMO patients, echocardiography has emerged as a clinical tool for implantation and clinical management, but to date, little data are available on COVID-related ARDS patients requiring ECMO. We assessed the incidence of RV dilatation and dysfunction (RvDys) in patients with COVID-related ARDS patients requiring ECMO. DESIGN: single-center investigation. SETTING: intensive care unit (ICU). PARTICIPANTS: 35 patients with COVID-related ARDS patients requiring ECMO, consectively admitted to our ICU (1 st March 2020 to 28(th) February 2021). INTERVENTIONS: serial echocardiographic examinations. RV Dys was defined as RVEDA/LVEDA > 0.6 and TAPSE < 15 mm. MEASUREMENTS AND MAIN RESULTS: The incidence of RvDys was 15/35 (42%). RVdys patients underwent ECMO support after a longer period of mechanical ventilation (p=0.006) and exhibited a higher mortality rate (p=0.024) than those without RVDys. In non survivors, RV Dys was observed in all patients (n.9), who died for unfavourable progression of COVID-related ARDS. In survivors, weaned from ECMO, a significant reduction in systolic pulmonary arterial pressures was detectable. CONCLUSIONS: According to our data, in COVID-related ARDS requiring ECMO support, RVDys is common, associated with increased ICU mortality. Overall our data underscore the clinical role of echocardiography in COVID-related ARDS supported by VV ECMO, since serial echocardiographic assessments (especially focused on RV changes) are able to reflect pulmonary COVID disease severity.