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

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 des...

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Autores principales:	Florence Daviet, Philippe Guilloux, Sami Hraiech, David Tonon, Lionel Velly, Jeremy Bourenne, Alizée Porto, Inès Gragueb-Chatti, Mickael Bobot, Karine Baumstarck, Laurent Papazian, Frédéric Collart, Jean-Marie Forel, Christophe Guervilly
Formato:	article
Lenguaje:	EN
Publicado:	SpringerOpen 2021
Materias:	COVID-19 ECMO ARDS Obesity Prognosis Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/6f025a272f45414ea225342e7a0e83e9
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spelling	oai:doaj.org-article:6f025a272f45414ea225342e7a0e83e92021-11-21T12:02:40ZImpact of obesity on survival in COVID-19 ARDS patients receiving ECMO: results from an ambispective observational cohort10.1186/s13613-021-00943-02110-5820https://doaj.org/article/6f025a272f45414ea225342e7a0e83e92021-11-01T00:00:00Zhttps://doi.org/10.1186/s13613-021-00943-0https://doaj.org/toc/2110-5820Abstract 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 PaO2:FiO2 of 71 mmHg (IQR 62–81), median PaCO2 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.Florence DavietPhilippe GuillouxSami HraiechDavid TononLionel VellyJeremy BourenneAlizée PortoInès Gragueb-ChattiMickael BobotKarine BaumstarckLaurent PapazianFrédéric CollartJean-Marie ForelChristophe GuervillySpringerOpenarticleCOVID-19ECMOARDSObesityPrognosisMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENAnnals of Intensive Care, Vol 11, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	COVID-19 ECMO ARDS Obesity Prognosis Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	COVID-19 ECMO ARDS Obesity Prognosis Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Florence Daviet Philippe Guilloux Sami Hraiech David Tonon Lionel Velly Jeremy Bourenne Alizée Porto Inès Gragueb-Chatti Mickael Bobot Karine Baumstarck Laurent Papazian Frédéric Collart Jean-Marie Forel Christophe Guervilly Impact of obesity on survival in COVID-19 ARDS patients receiving ECMO: results from an ambispective observational cohort
description	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 PaO2:FiO2 of 71 mmHg (IQR 62–81), median PaCO2 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.
format	article
author	Florence Daviet Philippe Guilloux Sami Hraiech David Tonon Lionel Velly Jeremy Bourenne Alizée Porto Inès Gragueb-Chatti Mickael Bobot Karine Baumstarck Laurent Papazian Frédéric Collart Jean-Marie Forel Christophe Guervilly
author_facet	Florence Daviet Philippe Guilloux Sami Hraiech David Tonon Lionel Velly Jeremy Bourenne Alizée Porto Inès Gragueb-Chatti Mickael Bobot Karine Baumstarck Laurent Papazian Frédéric Collart Jean-Marie Forel Christophe Guervilly
author_sort	Florence Daviet
title	Impact of obesity on survival in COVID-19 ARDS patients receiving ECMO: results from an ambispective observational cohort
title_short	Impact of obesity on survival in COVID-19 ARDS patients receiving ECMO: results from an ambispective observational cohort
title_full	Impact of obesity on survival in COVID-19 ARDS patients receiving ECMO: results from an ambispective observational cohort
title_fullStr	Impact of obesity on survival in COVID-19 ARDS patients receiving ECMO: results from an ambispective observational cohort
title_full_unstemmed	Impact of obesity on survival in COVID-19 ARDS patients receiving ECMO: results from an ambispective observational cohort
title_sort	impact of obesity on survival in covid-19 ards patients receiving ecmo: results from an ambispective observational cohort
publisher	SpringerOpen
publishDate	2021
url	https://doaj.org/article/6f025a272f45414ea225342e7a0e83e9
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Impact of obesity on survival in COVID-19 ARDS patients receiving ECMO: results from an ambispective observational cohort

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