Rami Bzeih, MD
University of Louisville
Louisville, Kentucky, United States
Disclosure information not submitted.
MacKenzie Mayo, M.D.
Internal Medicine Resident
St. Joseph Mercy- Ann Arbor, United States
Disclosure information not submitted.
Ibolya Csernak, M.D.
Internal Medicine Resident
St. Joseph Mercy- Ann Arbor, United States
Disclosure information not submitted.
Twylla Tassava, M.D.
Hospitalist
St. Joseph Mercy- Ann Arbor, United States
Disclosure information not submitted.
Title: Comparing Vascular Access and Complications in Patients with COVID19 and non-COVID19 ARDS
INTRODUCTION: When severe cases of SARS-CoV-2 (COVID19) require admission to the ICU, the presentation will often fulfill criteria for Acute Respiratory Distress Syndrome (ARDS). Some studies have attempted to define the differences between COVID19 related ARDS and non-COVID19 ARDS. However, there is little data on differences in use of vascular access. While central and arterial lines are essential for ICU care, there are risks associated with their use, notably infection, bleeding, and thrombosis. This study attempts to explore if there were differences in line usage rates and complications between patients with COVID19 ARDS and non-COVID19 ARDS.
Methods: This analysis was a retrospective cohort study. A cohort of patients with COVID19 ARDS (n = 86) was compared to a cohort of patients with non-COVID19 ARDS (n = 47). We compared baseline characteristics, total number and placement rate of lines (arterial lines, central venous catheters, and dialysis catheters) and incidence of line related complications (bleed, thrombosis, or infection).
Results: The COVID19 cohort had significantly higher total number of lines than the non-COVID cohort (p = 0.001). This was primarily due to significantly higher number of arterial lines (p = 0.009) and dialysis lines (p = 0.018). There was no significant difference in number of central venous catheters. When adjusted for length of stay in the ICU (line placement rate), only the rate of dialysis catheter placement remained significantly higher for the COVID19 group (p = 0.038). The total line replacement rate was not significantly different between the two cohorts. The number of patients who had a line related complication was 17.44% in the COVID19 group, compared to 4.26% in the non-COVID19 group. However, this difference did not achieve statistical significance due to low power (p = 0.057).
Conclusions: While the number of lines placed was significantly greater in the COVID19 group, this was attributable to their longer lengths of stay in the ICU. The increase in total line usage as well as increased rate of dialysis catheter placement likely contributes to the greater percentage of line related complications in patients with COVID19 ARDS compared to patients with non-COVID19 ARDS.