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Table 1 Patients’ characteristics and outcomes in the intensive care unit of patients with conventional or facilitative ECMO weaning

From: Short and long-term outcomes of patients with COVID-19-associated acute respiratory distress syndrome and difficult veno-venous-ECMO weaning

Parameters

Facilitative weaning (n = 18)

Conventional weaning (n = 16)

P value

Age, years

53 (45–57)

50 (44–58)

0.92

Male gender (%)

11 (61)

11 (69)

0.70

SAPS 2 score

35 (27–54)

35 (29–50)

0.98

BMI, kg/m2

29.1 (26.1–31.9)

34.5 (26.10–35.8)

0.40

Between ICU admission and ECMO weaning

   

History of previous lung disease

0 (0)

1 (6)

0.47

Chest CT-scan upon ICU admission

   

 Pulmonary embolism

1 (6)

2 (13)

0.59

 Lung parenchyma affected, %

68 (50–90)a

75 (50–75)b

0.50

Corticosteroids during ICU stay

   

 Dexamethasone

11 (61)

9 (56)

> 0.99

 Hydrocortisone/Fludrocortisone

8 (44)

4 (33)

0.30

 Methylprednisolone pulse therapy

2 (11)

1 (6)

> 0.99

Renal replacement therapy

7 (39)

5 (31)

0.73

Ventilator-associated pneumonia

17 (94)

10 (63)

0.030

Major bleedingc

13 (72)

4 (25)

0.015

ECMO support duration, days

24 (16–43)

10 (7–14)

< 0.001

At time of ECMO weaning trial

   

Ventilator settings during ECMO weaning

   

 Tidal volume, mL

345 (308–396)

400 (320–442)

0.10

 Tidal Volume, mL/kg PBW

5.6 (4.8–5.9)

5.8 (5.5–6.1)

0.20

 Respiratory rate, breaths/min

34 (30–38)

29 (26–32)

0.002

 Plateau pressure, cmH2O

31 (29–34)

25 (22–26)

< 0.001

 Driving pressure, cmH2O

24 (22–27)

13 (12–16)

< 0.001

 RS compliance, mL/cmH2O

14 (12–17)

27 (22–35)

< 0.001

 PEEP, cmH2O

5 (5–8)

10 (7–12)

0.003

Arterial blood gases during weaning

   

 pH

7.35 (7.27–7.38)

7.42 (7.36–7.44)

0.008

 PaCO2, mmHg

47 (42–55)

41 (37–44)

0.001

 PaO2, mmHg

82 (71–96)

84 (76–104)

0.37

 Arterial lactate levels, mmol/L

0.9 (0.6–1.2)

1.1 (0.9–1.4)

0.10

 HCO3−, mmol/L

27 (24–29)

27 (23–29)

0.90

 PaO2/FiO2 ratio, mmHg

166 (145–202)

200 (156–254)

0.25

 FiO2

50 (40–60)

50 (40–50)

0.29

BAL fluid cytological analysisd

   

 Total cell counts; 103/mL

474 (240–772)

500 (259–873)

0.90

 Macrophages, %

27 (12–48)

75 (18–89)

0.15

 Neutrophils, %

50 (27–71)

18 (5–50)

0.07

 Lymphocytes, %

9 (2–17)

4 (3–35)

0.67

 Eosinophils, %

1 (0–3)

0 (0–2)

0.24

Chest CT-scan at time of weaninge

   

 Reticular pattern

3 (21)

1 (8)

0.60

 Ground glass opacity

11 (78)

12 (100)

0.13

 Alveolar condensation

12 (86)

9 (75)

0.53

 Traction bronchiectasis

12 (86)

5 (12)

0.038

 Tracheal distorsion

1 (7)

0 (0)

> 0.99

 Scissural distortion

4 (29)

2 (16)

0.59

After ECMO withdrawal

   

MV with non-protective settingsf, days

6 (4–10)

1 (0–2)

< 0.0001

Rescue therapy after weaning

   

 Prone positioning

9 (50)

1 (6)

0.008

 Inhaled nitric oxide

4 (22)

1 (6)

0.34

 Methylprednisolone pulse therapy

1 (5)

0 (0)

–

RS mechanics on the day of MV weaning

   

 Pressure support level, cm H2O

11 (8–14)

10 (8–13)

0.60

 Tidal volume, mL

520 (411–609)

471 (397–622)

0.75

 Tidal volume, mL/kg PBW

7.2 (6.3–8.4)

7.0 (5.9–8.7)

0.98

 Complianceg, mL/cmH2O

44.7 (35.2–62.4)

48.9 (34.1–77.8)

0.78

Total MV duration, days

55 (38–86)h

21 (14–31)

0.0002

MV duration after ECMO weaning, days

26 (16–36)h

5 (3–12)

< 0.0001

ICU length of stay, days

55 (40–91)h

27 (19–32)

< 0.0001

In-ICU mortality

2 (13)h

1 (6)

0.60

  1. Continuous variables are expressed as median (interquartile range) and were compared with the Mann–Whitney test; Categorical variables are expressed as n (%) and were compared with χ2 or Fischer tests, as appropriate
  2. aAvailable for 14 patients
  3. bAvailable for 13 patients
  4. cMajor bleeding defined by Bleeding Academic Research Consortium (BARC) consensus classification type 3 or more; SAPS 2 Simplified Acute Physiology Score 2, BMI body mass index, ECMO extracorporeal membrane oxygenation, ICU intensive care unit, MV mechanical ventilation, PBW predicted body weight, RS respiratory system, PEEP positive end-expiratory pressure
  5. dAvailable for 12 patients in the facilitative weaning group and 5 patients in the conventional weaning group
  6. eAvailable for 14 patients in the facilitative weaning group and 12 patients in the conventional weaning group
  7. fDefined by the number of days with a plateau pressure ≥ 30 cm H2O and/or a driving pressure > 15 cm H2O
  8. gComputed as tidal volume (mL)/pressure support level (cm H2O)
  9. hOne patient was still in the ICU at the time of this report
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Critical Care

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