(1366) Factors and Outcomes Associated With Right Ventricular Dysfunction in VV ECMO Patients With ARDS

Introduction: Right ventricular dysfunction (RVD) is associated with mortality in acute respiratory distress syndrome (ARDS). This study’s aim was to investigate risk factors and outcomes associated with RVD in VV-ECMO patients, for whom evidence is sparse.

Methods: A retrospective analysis of ARDS patients treated with VV-ECMO between 2018 and 2022 was performed. Data on visual assessment (VA) of RV function (normal vs. RVD) and fractional area of change (FAC) (normal ≥ 35%) were abstracted for echocardiograms performed during ECMO. In patients with >1 echocardiogram, worst values were included in the analysis. Bivariate analyses examined baseline and clinical variables by RVD status, and logistic regression was used to evaluate correlation of FAC with mortality.

Results: Median age of patients (n=79) was 50, SOFA score 7, P/F ratio 62.5, and plateau pressure 31. 69.6% were male, 60.8% had COVID-19, and the median number of echocardiograms per patient was 2 (range 1-5). The prevalence of RVD was 46.8% and did not differ by COVID status. Compared to patients with normal RV function, patients with RVD were predominantly male (81.1% vs. 59.5%, p=0.04), had a higher degree of hypercapnia at the time of ECMO initiation (median pCO2 74 vs. 62, p=0.02), and higher incidence of ischemic stroke (10.8% vs. 0%, p=0.04) and pneumothorax (29.7% vs. 11.9%, p=0.05) during their ECMO course. Patients with RVD had longer ICU (41 vs. 24 days, p=0.007) and hospital (43 vs. 32.5 days, p = 0.03) stays and ECMO duration (31 vs. 13.5 days, p< 0.001). Among patients with FAC measurements (n=59), in-hospital mortality decreased by 3.5% for every 1% increase in FAC (RR=0.965, 95% CI 0.936-0.995, p=0.02). Of 39 patients with multiple echocardiograms, 18 began ECMO with normal RV function and 9 of those subsequently developed RVD. Conversely, RV function normalized for 10 of 21 cases with RVD documented at ECMO initiation.

Conclusions: Male sex and increased severity of hypercarbia prior to ECMO initiation were associated with RVD. Patients with RVD had a higher rate of ischemic stroke and pneumothorax, required longer treatment duration, and experienced higher mortality. RVD can develop despite ECMO support thus monitoring with serial echocardiograms is warranted.