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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