Cardiac Function in Critically Ill Patients with Severe COVID: A Prospective Cross-Sectional Study in Mechanically Ventilated Patients.

Purpose: To evaluate cardiac function in mechanically ventilated patients with COVID-19.Materials and methods: Prospective, cross-sectional multicenter study in four university-affiliated hospitals in Chile. All consecutive patients with COVID-19 ARDS requiring mechanical ventilation admitted between April and July 2020 were included. We performed systematic transthoracic echocardiography assessing right and left ventricular function within 24 h of intubation.Results: 140 patients aged 57 +/- 11, 29% female were included. Cardiac output was 5.1 L/min [IQR 4.5-6.2] and 86% of the patients required norepinephrine. ICU mortality was 29% (40 patients). Fifty-four patients (39%) ex-hibited right ventricle dilation out of whom 20 patients (14%) exhibited acute cor pulmonale (ACP). Eight out of the twenty patients with ACP exhibited pulmonary embolism (40%). Thirteen patients (9%) exhibited left ven-tricular systolic dysfunction (ejection fraction < 45%). In the multivariate analysis acute cor pulmonale and PaO2/ FiO(2) ratio were independent predictors of ICU mortality.Conclusions: Right ventricular dilation is highly prevalent in mechanically ventilated patients with COVID-19 ARDS. Acute cor pulmonale was associated with reduced pulmonary function and, in only 40% of patients, with co-existing pulmonary embolism. Acute cor pulmonale is an independent risk factor for ICU mortality.