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296: Determinants of ARDS resolution and duration in patients supported with extracorporeal support

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Title: 296: Determinants of ARDS resolution and duration in patients supported with extracorporeal support
Authors: Shroff, D
Garfield, B
Banya, W
Ledot, S
Patel, B
Item Type: Conference Paper
Abstract: Introduction: Extracorporeal membrane oxygenation (ECMO) is used to provide life-sustaining support to patients with severe acute respiratory distress syndrome (ARDS). Its use has dramatically increased during the current COVID-19 pandemic. Delayed resolution is associated with poorer patient outcomes and current prediction scores focus on mortality. This study aimed to identify pre-ECMO clinical characteristics that determine early ARDS resolution, to assist clinicians in planning appropriate treatment. Methods: In this retrospective observational study, point of referral data from patients treated with veno-venous ECMO at a regional centre (2017-2019) were analysed. Patients aged 18 years and above with ARDS, defined by the Berlin criteria, were included. The primary outcome was early ARDS resolution, defined as liberation from ECMO within 14 days, or non-early ARDS resolution, defined as ECMO run longer than 14 days (survivors and non-survivors). Multiple logistic and backwards step-wise logistic regression were used to identify independent predictors. Multiple imputation was used for missing values. Results: Of the 159 patients included in the study, 86 (54.1%) had early ARDS resolution. Following univariate analysis and exclusion of colinear variables, multiple logistic regression showed aspiration pneumonia to be a significant predictor of early resolution. Plateau pressure, social alcohol use and prophylactic heparin were significant predictors of non-early resolution. Backwards step-wise regression retained plateau pressure (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.06-1.24, p=0.001), social alcohol use (OR 2.73, 95% CI 1.17-6.34, p=0.020), prophylactic heparin (OR 3.24, 95% CI 1.46-7.21, p=0.004), aspiration pneumonia (OR 0.19, 95% CI 0.06-0.62, p=0.006) and log (FiO2) (OR 0.06, 95% CI 0.005-0.64, p=0.02) as independent significant predictors. Conclusions: This study identified important clinical characteristics at the point of referral, in particular the aetiology of ARDS, that predict disease dynamics in ARDS patients receiving ECMO. These can help better prepare families, inform clinicians, plan resource utilization and guide future research into severe ARDS.
Issue Date: 1-Jan-2021
Date of Acceptance: 1-Jan-2021
URI: http://hdl.handle.net/10044/1/91119
DOI: 10.1097/01.ccm.0000727072.96128.16
ISSN: 0090-3493
Publisher: Lippincott, Williams & Wilkins
Start Page: 135
End Page: 135
Journal / Book Title: Critical Care Medicine
Volume: 49
Issue: 1
Copyright Statement: © 2020 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Conference Name: 50th Critical Care Congress
Keywords: Science & Technology
Life Sciences & Biomedicine
Critical Care Medicine
General & Internal Medicine
Science & Technology
Life Sciences & Biomedicine
Critical Care Medicine
General & Internal Medicine
Emergency & Critical Care Medicine
1103 Clinical Sciences
1110 Nursing
1117 Public Health and Health Services
Publication Status: Published
Start Date: 2021-01-31
Finish Date: 2021-02-12
Conference Place: Virtual event
Online Publication Date: 2021-01-01
Appears in Collections:Department of Surgery and Cancer