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 2 Ventilation parameters on ECMO day 1, ECMO-related data, transfusions, and therapy during clinical course according to ICU mortality

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
ICU LOS, median (IQR)—days	31 (20.7–51) n = 100	41 (23.8–58.8) n = 60	23 (13.8–36) n = 41	0.0011
Lung transplantation, no. (%)	15 (15) n = 101	12 (20)	3 (7)	0.0937
Ventilation during ECMO day 1
PEEP, mean (SD)—cmH₂O	12 (± 2) n = 101	12 (± 2) n = 60	13 (± 3) n = 41	0.2034
Tidal volume, mean (SD)—ml	270 (± 121) n = 101	260 (± 128) n = 60	284 (± 112) n = 41	0.267
Tidal volume, mean (SD)—ml/kg IBW	4 (± 2) n = 101	4 (± 2) n = 60	4 (± 2) n = 41	0.4715
Respiratory rate, mean (SD)—/min	15 (± 5) n = 101	16 (± 6) n = 60	15 (± 5) n = 41	0.4568
Plateau pressure, mean (SD)—cmH₂O	26 (± 5) n = 101	25 (± 2) n = 60	28 (± 5) n = 41	0.0076
Peak pressure, mean (SD)—cmH₂O	26 (± 5) n = 101	25 (± 2) n = 60	28 (± 5) n = 41	0.0076
Driving pressure, mean (SD)—cmH₂O	14 (± 2) n = 101	13 (± 2) n = 60	15 (± 4) n = 41	0.0191
Mechanical power, median (IQR)—J/min	9 (6.1–13.2) n = 101	8.5 (5.5–12.2) n = 60	10 (6.5–15.6) n = 41	0.2611
ECMO configuration	.	.	.	0.4449
Venoarterial, no. (%)	4 (4)	1 (2)	3 (7)	.
Venovenoarterial, no. (%)	2 (2)	1 (2)	1 (3)	.
Venovenous, no. (%)	95 (95)	58 (97)	38 (93)	.
ECMO duration, median (IQR)—days	16.4 (8.7–27.7) n = 101	16.5 (10.8–28) n = 60	15 (6.4–24.2) n = 41	0.2567
ECMO blood flow, mean (SD)—L/min	3.7 (± 1) n = 96	4 (± 1) n = 57	4 (± 1) n = 39	0.41
During ECMO
PRBCs, median (IQR)—units per patient	10 (4–15) n = 99	9.5 (4.2–15) n = 58	11 (4.8–15.5) n = 41	0.8449
Albumin, median (IQR)—units per patient	14 (5–27) n = 99	13.5 (6–30.8) n = 58	15 (5–21.5) n = 41	0.4706
Platelet concentrates, no. (%)	20 (20) n = 99	9 (16) n = 58	11 (27) n = 41	0.2599
FFP, no. (%)	16 (16) n = 99	12 (21) n = 58	4 (10) n = 41	0.2386
NMBA, no. (%)	96 (98) n = 98	57 (97) n = 59	39 (95) n = 41	0.5645
Proning, no. (%)	100 (99) n = 101	60 (100) n = 60	40 (98) n = 41	0.4059
iNO, no. (%)	54 (53) n = 101	29 (48) n = 60	25 (61) n = 41	0.3135
Dexamethasone, no. (%)	50 (100) n = 101	28 (100) n = 60	22 (100) n = 41	0.5464
Tracheostomy, no. (%)	44 (51)	32 (67)	12 (32)	.
Outcome
ICU death, no. (%)	41 (41) n = 101	.	.	.
Hospital death, no. (%)	44 (51) n = 87	.	.	.

Metric data are reported by mean (± SD) or by median (IQR), n gives the number of available observations
ICU intensive care unit, PEEP positive end-expiratory pressure, IBW ideal body weight, ECMO extracorporeal membrane oxygenation, LOS length of stay, PRBC packed red blood cells, FFP fresh frozen plasma, NMBA neuromuscular blocking agents, iNO inhaled nitric oxide, P_insp inspiratory pressure. 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 x tidal volume (l) × (Δ P_insp + PEEP)

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