Impact of COVID-19-associated Dysautonomia Phenotypes on the Effectiveness of Venovenous Extracorporeal Membrane Oxygenation

Abstract

   RELEVANCE. It is known that patients with severe cases of the novel coronavirus infection (COVID-19) are characterized by the development of COVID-19-associated dysautonomia (COVID-19-DA). At the moment, there are no studies examining the impact of this phenomenon on the course and outcomes of the disease in the most severe cohort of patients with COVID-19, namely those requiring venovenous extracorporeal membrane oxygenation (VV ECMO).  AIM OF STUDY. The purpose of the presented work is to study the effect of different COVID-19-DA phenotypes on the performance parameters and effectiveness of VV ECMO, gas exchange and hemodynamics in patients with COVID-19.   MATERIAL AND METHODS. The study included 20 patients, 12 (60%) women, 8 (40%) men, with COVID-19 who underwent VV ECMO. Patients underwent 24-hour Holter monitoring with assessment of the spectral parameters of heart rate variability (HRV): the low-frequency component (LF), the high-frequency component (HF), the ratio of the low-frequency component to the high frequency component (LF / HF) on days 1, 3, 5 of the VV ECMO. Patients were divided into three groups based on the identified COVID-19-DA phenotypes. The groups were compared in terms of gas exchange, hemodynamics, and VV ECMO performance parameters.   RESULTS. The level of partial pressure of carbon dioxide in arterial blood (paCO2) in the phenotype with low sympathetic tone and high tone of the parasympathetic division of the autonomic nervous system (ANS) (lShP) was significantly higher than in the phenotype with normal sympathetic tone and high tone of the parasympathetic division of the ANS (nShP) with equal VV ECMO performance parameters. The heart rate (HR) in the nShP phenotype was significantly lower than in the lShP phenotype. A significant increase in respiratory dysfunction was revealed over time in the lShP phenotype. Weaning from VV ECMO in the nShP phenotype was successful in 50 %, whereas in the lShP phenotype, weaning from VV ECMO was observed in 7,2 % of patients. No significant differences in the mortality rate were obtained. The most common cause of death in both groups was septic shock.   CONCLUSIONS. The COVID-19-DA phenotype, manifested by decreased tone of the sympathetic division and increased tone of the parasympathetic division of the ANS, leads to low efficiency of VV ECMO, resulting in a statistically significantly less frequent ECMO discontinuation in those patients.