Duration of invasive mechanical ventilation prior to extracorporeal membrane oxygenation is not associated with survival in acute respiratory distress syndrome caused by coronavirus disease 2019

Hermann, Martina; Laxar, Daniel; Krall, Christoph; Hafner, Christina; Herzog, Oliver; Kimberger, Oliver; Koenig, Sebastian; Kraft, Felix; Maleczek, Mathias; Markstaller, Klaus; Robak, Oliver; Rössler, Bernhard; Schaden, Eva; Schellongowski, Peter; Schneeweiss-Gleixner, Mathias; Staudinger, Thomas; Ullrich, Roman; Wiegele, Marion; Willschke, Harald; Zauner, Christian; Hermann, Alexander

doi:10.1186/s13613-022-00980-3

Annals of Intensive Care

Table 1 Demographic data and baseline characteristics, ventilation parameters before ECMO day 0

From: Duration of invasive mechanical ventilation prior to extracorporeal membrane oxygenation is not associated with survival in acute respiratory distress syndrome caused by coronavirus disease 2019

	All patients n = 101	ICU survivors n = 60	ICU non-survivors n = 41	p value
Age, mean (SD)—years	56 (± 10) n = 101	52 (± 10) n = 60	61 (± 7) n = 41	< 0.001
Sex, male, no. (%)	71 (70)	39 (65)	32 (78)	0.2655
BMI, mean (SD)—kg/m²	31 (± 6) n = 101	31 (± 6) n = 60	31 (± 6) n = 41	0.946
RESP score, median (IQR)	2 (1–4) n = 101	2 (1–4) n = 60	1 (0–2) n = 41	0.001
SOFA, median (IQR)	8 (7–10) n = 101	8 (7–9) n = 60	9 (8–11) n = 41	0.0002
Apache II, mean (SD)	20 (± 3) n = 67	19 (± 3) n = 45	21 (± 3) n = 22	0.2791
IMV pre-ECMO, median (IQR)—days	7.7 (3.6–12.5) n = 101	7.8 (2.5–12.5) n = 60	6.8 (4–12.4) n = 41	0.9586
IMV < 7 days, no. (%)	48 (48) n = 101	27 (45) n = 60	21 (51) n = 41	0.6805
IMV < 10 days, no. (%)	66 (65) n = 101	39 (65) n = 60	27 (66) n = 41	1
Comorbidities
Arterial hypertension, no. (%)	60 (59) n = 101	32 (53) n = 60	28 (68) n = 41	0.1946
Coronary artery disease, no. (%)	13 (13) n = 101	7 (12) n = 60	6 (15) n = 41	0.765
Obesity, no. (%)	35 (35) n = 101	22 (37) n = 60	13 (32) n = 41	0.7631
Diabetes mellitus, no. (%)	25 (25) n = 101	14 (23) n = 60	11 (27) n = 41	0.8689
Underlying pulmonary disease, no. (%)	19 (19) n = 101	8 (13) n = 60	11 (27) n = 41	0.1484
Immunosuppression, no. (%)	3 (3) n = 101	1 (2) n = 60	2 (5) n = 41	0.5645
Chronic kidney disease, no. (%)	6 (6) n = 101	5 (8) n = 60	1 (2) n = 41	0.3967
No underlying disease, no. (%)	19 (19) n = 101	14 (23) n = 60	4 (10) n = 41	0.1124
Pre-ECMO
PaO₂/FiO₂, median (IQR)	74.2 (61–109) n = 93	82.7 (63.1–121.7) n = 54	72.3 (60.3–86.7) n = 39	0.1818
PaO₂, median (IQR)—mmHg	81.8 (70.3–96.4) n = 101	82.2 (71.5–94.8) n = 60	81 (69.3–96.5) n = 41	0.6332
PaCO₂, median (IQR)—mmHg	47.8 (41.9–56.3) n = 101	49.5 (42.6–55) n = 60	45.8 (40.9–56.3) n = 41	0.2715
pH, median (IQR)—mmHg	7.4 (7.4–7.5) n = 101	7.4 (7.4–7.5) n = 60	7.4 (7.4–7.5) n = 41	0.841
BE, median (IQR)—mmol/L	6.7 (3.9–9.1) n = 101	7.1 (4.2–9.3) n = 60	5.7 (2.7–8.9) n = 41	0.354
Prone positioning, no. (%)	101 (100) n = 101	60 (100) n = 60	41 (100) n = 41	1
iNO, no. (%)	22 (21) n = 101	10 (17) n = 60	12 (29) n = 41	0.4812
Tracheostomy, no. (%)	5 (6)	2 (4)	3 (8)	.
Ventilation pre-ECMO day 0
PEEP, mean (SD)—cmH₂O	13 (± 3) n = 94	13 (± 4) n = 55	13 (± 3) n = 39	0.6673
Tidal volume, mean (SD)—ml	443 (± 149) n = 94	442 (± 172) n = 55	443 (± 110) n = 39	0.9854
Tidal volume, mean (SD)—ml/kg IBW	6 (± 2) n = 89	6 (± 3) n = 54	7 (± 2) n = 39	0.7108
Respiratory rate, mean (SD)—/min	22 (± 5) n = 94	22 (± 5) n = 55	23 (± 5) n = 39	0.3307
Plateau pressure, mean (SD)—cmH₂O	31 (± 5) n = 94	31 (± 6) n = 55	31 (± 5) n = 39	0.5097
Peak pressure, mean (SD)—cmH₂O	31 (± 5) n = 94	31 (± 6) n = 55	31 (± 5) n = 39	0.5097
Driving pressure, mean (SD)—cmH₂O	18 (± 5) n = 94	18 (± 6) n = 55	19 (± 4) n = 39	0.3251
Mechanical power, median (IQR)—J/min	30 (22–38) n = 94	29 (21–38) n = 55	31 (24–37) n = 39	0.5142

Metric data are reported by mean (± SD) or by median (IQR), n gives the number of available observations. Variation in RESP score was due almost exclusively to variation in age, therefore we also considered a version of the RESP score without age
ICU intensive care unit, RESP respiratory ECMO survival prediction, SOFA Sequential Organ Failure Assessment, IMV invasive mechanical ventilation, BMI body mass index, PaO₂ partial pressure of arterial oxygen, FiO₂ fraction of inspired oxygen, PaCO₂ partial pressure of arterial carbon dioxide, BE base excess, iNO inhaled nitric oxide, IBW ideal body weight. IBW female = 45.5 + 0.9 * (height [cm]—152); IBW male = 50 + 0.9 * (height [cm]—152); driving pressure = peak pressure—PEEP; mechanical power = 0.098 × respiratory rate × tidal volume (l) × (Δ P_insp + PEEP)

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