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Annals of Intensive Care

Table 2 Comparison of patient’s characteristics according to their survival at day 90 in univariate analysis

From: Impact of obesity on survival in COVID-19 ARDS patients receiving ECMO: results from an ambispective observational cohort

 

All (n = 76)

Survivors at D90 (n = 39)

Non-survivors at D90 (n = 37)

p value

Demographic characteristics

 Age (years)

61 (54–64.5)

58 (49–62)

63 (59–66)

< 0.001

 Male sex, n (%)

59 (77.6)

30 (77)

29 (78)

0.88

 BMI (kg/m2)

28.1 (26.1–31.8)

30.5 (27.2–35)

27.2 (25.6–29.9)

0.002

 Obesitya

29 (39.7%)

21 (53.8%)

8 (23.5%)

0.008

ECMO Referral Center, n (%)

42 (55)

23 (59)

19 (51)

0.50

 Transfer from referring hospital by ECMO mobile team

33 (43)

19 (49)

14 (38)

0.34

Characteristics of Sars-CoV 2 pneumonia and treatments

 First wave, n (%)

23 (30)

18 (46)

5 (13.5)

0.002

 Time from first symptoms to ICU admission, (days)

7 (5.5–10)

5 (4–7)

6 (4–7)

0.43

 Time from ICU admission to intubation, (days)

3 (0–6)

2 (0–5)

4 (1–7)

0.02

 Sars-CoV 2 treatment

  Dexamethasoneb n (%)

54 (67)

21 (54)

33 (92)

< 0.001

  Hydroxychloroquine, n (%)

24 (32)

17 (44)

7 (19)

0.02

  Antiviral treatment, n (%)

   Lopinavir/ritonavir

3 (4)

3 (8)

0 (0)

0.08

  Immunomodulatory treatment, n (%)

   Anti-IL 6 treatment

6 (8)

4 (10)

2 (5)

0.43

   Anti- IL 1 treatment

12 (16)

8 (20.5)

4 (11)

0.25

   Janus kinase 1/2 inhibitor

14 (18)

8 (20.5)

6 (16)

0.63

   High-dose corticosteroid

47 (62)

22 (56)

25 (68)

0.32

ICU admission scores

 Charlson score

2 (1.5–3)

2 (1–3)

3 (2–3)

0.003

 SAPS II

30 (27–36)

29 (23–36)

31 (27–38.5)

0.42

 SOFA

3 (2–4)

3 (2–4)

3 (2–5)

0.76

ICU therapy before ECMO

 High-flow nasal O2, n (%)

67 (88)

32 (82)

35 (95)

0.09

  Duration (days)

3 (1–6)

2.5 (1–6)

4 (1–7)

0.14

 Non-invasive ventilation, n (%)

37 (49)

17 (44)

20 (54)

0.36

  Duration (days)

1 (0–6)

1 (0–6)

1 (0–6)

0.70

 Almitrine, n (%)

12 (16)

6 (16)

6 (17)

0.92

 Inhaled nitric oxide, n (%)

53 (70)

28 (72)

25 (68)

0.69

 Prone positioning, n (%)

75 (99)

38 (97)

37 (100)

0.33

  Number of sessions

2 (1–4)

2 (1–4)

2 (1–4)

0.85

 MV duration before ECMO

6 (3–10)

5 (3–9)

7 (3–11)

0.43

Ventilation parameters before ECMO

 FiO2

100 (100–100)

100

100

0.58

 Plateau pressure, (cmH2O)

28 (25–30)

28 (24–31)

28 (26–30)

0.71

 Positive end-expiratory pressure, (cmH2O)

12 (9.5–14)

12 (10–14)

12 (9–14)

0.38

 Tidal volume, (mL/kg predicted bodyweight)

5.8 (5.1–6.2)

5.7 (5–6.1)

6.04 (5.3–6.3)

0.15

 Respiratory rate, (breath per minute)

27 (23–30)

26 (23–30)

28 (21–30)

0.92

 Mechanical power, (L/min)

19.7 (15.7–24)

19.4 (15.8–22.4)

19.99 (14.07–24.34)

0.74

 Ventilatory ratio

2.42 (1.71–2.84)

2.32 (1.79–2.84)

2.42 (1.55–2.88)

0.90

 Static compliance, (mL/cmH2O)

23 (16.7–28.6)

23.3 (15.2–30.8)

22.7 (20–27.3)

0.63

Last blood-gas values before ECMO

 PaO2/FiO2 ratio

71.5 (62–81)

72.5 (60–83)

71.5 (65.5–80)

0.97

 pH

7.33 (7.25–7.38)

7.31 (7.25–7.39)

7.35 (7.25–7.37)

0.73

 PaCO2, (mmHg)

58 (51–66)

58 (52–66)

58 (49–66)

0.85

Predictive survival scores under ECMO

 RESP score

1 (0–2)

1 (1–4)

1 (0–2)

0.01

 ECMO net score

5 (4–6)

4.5 (4–6)

5 (4–6.25)

0.79

 PRESERVE score

3 (2–4)

2 (1–4)

3 (3–5)

< 0.001

 Last SOFA before ECMO

7 (4–9)

7 (4–10)

7 (4.5–9)

0.94

  Respiratory component of SOFA

4 (4–4)

4 (4–4)

4 (4–4)

0.33

  Cardiovascular component of SOFA

2 (0–4)

3 (0–4)

1 (0–4)

0.62

  Hematological component of SOFA

0 (0–0

0 (0–0)

0 (0–0)

0.55

  Renal component of SOFA

0 (0–1)

0 (0–0)

0 (0–0)

0.09

Time from ICU admission to ECMO, (days)

10.5 (7–13)

9 (4–11)

11 (8–14)

0.02

ECMO assistance duration, (days)

18 (11–31.5)

14 (9–23)

27 (15–39)

< 0.001

Prone positioning during ECMO, n (%)

61 (80)

33 (85)

28 (76)

0.33

 Number of sessions

2 (1–4)

2 (1–4)

3 (0.5–5)

0.51

Outcomes

 ECMO weaning, n (%)

45 (59)

38 (97)

7 (19)

< 0.001

 MV duration (days)

41 (27.5–54.5)

41 (29–57)

41 (25–53)

0.23

 Complications occurred during the ECMO period, n (%)

  Intravascular hemolysis

34 (45)

14 (37)

20 (54)

0.13

  Severe bleeding

42 (57)

11 (29)

31 (86)

< 0.001

  Clogged circuit

11 (15)

6 (16)

5 (14)

0.82

  Infection

    Ventilatory-acquired pneumonia

45 (61)

19 (50)

26 (72)

0.05

    Bacteremia

33 (44)

16 (42)

17 (46)

0.74

    Septic shock

45 (61)

16 (36)

29 (64)

0.001

    CMV reactivation

32 (43)

13 (34)

19 (53)

0.16

    CMV pneumonia

22 (29)

9 (23)

13 (35)

0.25

    HSV reactivation

21 (28)

9 (24)

12 (33)

0.44

    HSV pneumonia

14 (18)

6 (15)

8(22)

0.56

  Arterial or venous thrombosis

36 (47)

27 (69)

9 (24)

< 0.001

   Deep vein thrombosis or pulmonary thrombosis

34 (45)

26 (67)

8 (22)

< 0.001

  Heparin-induced thrombocytopenia

3 (4)

3 (8)

0

0.08

  Circuit change

30 (39)

13 (33)

17 (46)

0.26

   Number of circuit change

0 (0–1)

0 (0–1)

0 (0–1)

0.02

   Renal replacement therapy

25 (33)

8 (20)

17 (68)

0.02

  1. Data are expressed as median (interquartiles) or number (percentage, %). Obesity was defined by a BMI superior or equal to 30 g/m2
  2. Mechanical power (MP) was calculated as follows: MP = 0.098 × tidal volume × respiratory rate × (peak pressure − ½ × driving pressure). Driving pressure was defined as plateau pressure minus positive end-expiratory pressure. Static compliance was defined as tidal volume divided by driving pressure
  3. BMI: body mass index; NSAID: non-steroidal anti-inflammatory drug; ACE: angiotensin converting enzyme; ARB: angiotensin II receptor blockers; SAPS II: Simplified Acute Physiology score; SOFA: Sequential Organ Function; ICU: intensive care unit; ECMO: extra-corporeal membrane oxygenation; MV: mechanical ventilation; O2: oxygen; PaO2: partial pressure of arterial oxygen; FiO2: fraction of Inspired oxygen; PaCO2: partial pressure of arterial carbon dioxide; PaO2/FiO2: ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen; RESP score [17]: Respiratory Extracorporeal Membrane Oxygenation Survival Prediction Score; ECMO net score [18]: score from the Italian ECMO network; PRESERVE score [19]: PRedicting dEath for SEvere ARDS on VV-ECMO score
  4. a3 patients had missing data for BMI
  5. bPatients receiving dexamethasone 6 mg per day or equivalent dose of corticosteroids
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