tetano
Editor, Senior Moderator
Ann Intensive Care
. 2021 Nov 15;11(1):157.
doi: 10.1186/s13613-021-00943-0.
Impact of obesity on survival in COVID-19 ARDS patients receiving ECMO: results from an ambispective observational cohort
Florence Daviet[SUP] 1 2 [/SUP], Philippe Guilloux[SUP] 3 [/SUP], Sami Hraiech[SUP] 4 5 [/SUP], David Tonon[SUP] 3 [/SUP], Lionel Velly[SUP] 3 [/SUP], Jeremy Bourenne[SUP] 6 [/SUP], Alizée Porto[SUP] 7 [/SUP], Inès Gragueb-Chatti[SUP] 4 [/SUP], Mickael Bobot[SUP] 4 [/SUP], Karine Baumstarck[SUP] 8 [/SUP], Laurent Papazian[SUP] 4 5 [/SUP], Frédéric Collart[SUP] 7 [/SUP], Jean-Marie Forel[SUP] 4 5 [/SUP], Christophe Guervilly[SUP] 4 5 [/SUP]
Affiliations
Abstract
Background: Since March 2020, health care systems were importantly affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak, with some patients presenting severe acute respiratory distress syndrome (ARDS), requiring extra-corporeal membrane oxygenation (ECMO). We designed an ambispective observational cohort study including all consecutive adult patients admitted to 5 different ICUs from a university hospital. The main objective was to identify the risk factors of severe COVID-19 ARDS patients supported by ECMO associated with 90-day survival.
Results: Between March 1st and November 30th 2020, 76 patients with severe COVID-19 ARDS were supported by ECMO. Median (interquartile range IQR) duration of mechanical ventilation (MV) prior to ECMO was of 6 (3-10) days. At ECMO initiation, patients had a median PaO[SUB]2[/SUB]:FiO[SUB]2[/SUB] of 71 mmHg (IQR 62-81), median PaCO[SUB]2[/SUB] of 58 mmHg (IQR 51-66) and a median arterial pH of 7.33 (IQR 7.25-7.38). Forty-five patients (59%) were weaned from ECMO. Twenty-eight day, 60-day and 90-day survival rates were, respectively, 92, 62 and 51%. In multivariate logistic regression analysis, with 2 models, one with the RESP score and one with the PRESERVE score, we found that higher BMI was associated with higher 90-day survival [odds ratio (OR): 0.775 (0.644-0.934), p = 0.007) and 0.631 (0.462-0.862), respectively]. Younger age was also associated with 90-day survival in both models [OR: 1.1354 (1.004-1.285), p = 0.044 and 1.187 (1.035-1.362), p = 0.014 respectively]. Obese patients were ventilated with higher PEEP than non-obese patients and presented slightly higher respiratory system compliance.
Conclusion: In this ambispective observational cohort of COVID-19 severe ARDS supported by ECMO, obesity was an independent factor associated with improved survival at 90-day.
Keywords: ARDS; COVID-19; ECMO; Obesity; Prognosis.
. 2021 Nov 15;11(1):157.
doi: 10.1186/s13613-021-00943-0.
Impact of obesity on survival in COVID-19 ARDS patients receiving ECMO: results from an ambispective observational cohort
Florence Daviet[SUP] 1 2 [/SUP], Philippe Guilloux[SUP] 3 [/SUP], Sami Hraiech[SUP] 4 5 [/SUP], David Tonon[SUP] 3 [/SUP], Lionel Velly[SUP] 3 [/SUP], Jeremy Bourenne[SUP] 6 [/SUP], Alizée Porto[SUP] 7 [/SUP], Inès Gragueb-Chatti[SUP] 4 [/SUP], Mickael Bobot[SUP] 4 [/SUP], Karine Baumstarck[SUP] 8 [/SUP], Laurent Papazian[SUP] 4 5 [/SUP], Frédéric Collart[SUP] 7 [/SUP], Jean-Marie Forel[SUP] 4 5 [/SUP], Christophe Guervilly[SUP] 4 5 [/SUP]
Affiliations
- PMID: 34779944
- DOI: 10.1186/s13613-021-00943-0
Abstract
Background: Since March 2020, health care systems were importantly affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak, with some patients presenting severe acute respiratory distress syndrome (ARDS), requiring extra-corporeal membrane oxygenation (ECMO). We designed an ambispective observational cohort study including all consecutive adult patients admitted to 5 different ICUs from a university hospital. The main objective was to identify the risk factors of severe COVID-19 ARDS patients supported by ECMO associated with 90-day survival.
Results: Between March 1st and November 30th 2020, 76 patients with severe COVID-19 ARDS were supported by ECMO. Median (interquartile range IQR) duration of mechanical ventilation (MV) prior to ECMO was of 6 (3-10) days. At ECMO initiation, patients had a median PaO[SUB]2[/SUB]:FiO[SUB]2[/SUB] of 71 mmHg (IQR 62-81), median PaCO[SUB]2[/SUB] of 58 mmHg (IQR 51-66) and a median arterial pH of 7.33 (IQR 7.25-7.38). Forty-five patients (59%) were weaned from ECMO. Twenty-eight day, 60-day and 90-day survival rates were, respectively, 92, 62 and 51%. In multivariate logistic regression analysis, with 2 models, one with the RESP score and one with the PRESERVE score, we found that higher BMI was associated with higher 90-day survival [odds ratio (OR): 0.775 (0.644-0.934), p = 0.007) and 0.631 (0.462-0.862), respectively]. Younger age was also associated with 90-day survival in both models [OR: 1.1354 (1.004-1.285), p = 0.044 and 1.187 (1.035-1.362), p = 0.014 respectively]. Obese patients were ventilated with higher PEEP than non-obese patients and presented slightly higher respiratory system compliance.
Conclusion: In this ambispective observational cohort of COVID-19 severe ARDS supported by ECMO, obesity was an independent factor associated with improved survival at 90-day.
Keywords: ARDS; COVID-19; ECMO; Obesity; Prognosis.