09-Evaluation of Aerosolized Epoprostenol in COVID-19 ARDS Patients
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Pulmonary, Crisis Management, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.


Mahmoud A. Ammar, BCCCP, BCPS, PharmD

Introduction/Hypothesis: ARDS contributes to high mortality and morbidity observed with coronavirus disease 2019 (COVID-19). Epoprostenol has antithrombotic, antiproliferative, and vasodilatory properties and improves respiratory parameters in ARDS. The role of aerosolized epoprostenol (aEPO) in COVID-19 has not been evaluated. We hypothesized that aEPO may improve oxygenation in intubated COVID-19 patients.

Methods: We performed a single-center, retrospective, propensity-score matched cohort study. A medical chart review was conducted for COVID-19 ARDS adult patients admitted between March 1, 2020 and May 1, 2020. Patients receiving aEPO (0.05 mcg/kg/minute) versus patients not receiving aEPO were matched for Rothman index and baseline PaO2:FiO2 (PF) ratios, and evaluated for effect of aEPO on PF ratio, gradient between arterial to end-tidal CO2, and dead space (primary endpoints). Secondary endpoints evaluated included in-hospital mortality, mechanical ventilation-free days, and ICU and hospital length of stay. Safety endpoints evaluated included incidence of hypotension, significant bleeding, thrombocytopenia, and rebound hypoxemia.

Results: Nineteen patients treated with aEPO were compared to 19 propensity-matched controls. Baseline characteristics were well matched. Management of ARDS was similar between groups. The mean ± SD duration of aEPO treatment was 5 ± 2.8 days. There were no significant differences in PF ratios between aEPO cohort and non-aEPO cohort at 3 hours (125 ± 56 vs 115 ± 40 mmHg), 6 hours (124 ± 41 vs 147 ± 73 mmHg), 12 hours (112 ± 39 vs 163 ± 62 mmHg), 24 hours (114 ± 33 vs 176 ± 64 mmHg), and 48 hours (150 ± 54 vs 212 ± 84 mmHg), although there was a trend toward higher PF ratios for the control group. There were no significant differences in gradient between arterial to end-tidal CO2 and dead space between cohorts. There were significantly more deaths in the control group compared to aEPO by day 10 (21% vs 0, p<0.05), though there was no difference in 28-day mortality (41% vs 48%, p=0.35). There were no significant differences in other secondary and safety end points.

Conclusions: In this small case-control study, aEPO did not demonstrate better efficacy or safety compared to not receiving aEPO. Large randomized control trials are needed to confirm early survival benefit noted with aEPO.

Meta Tag
Content Type Presentation
Knowledge Area Pulmonary
Knowledge Area Crisis Management
Knowledge Level Advanced
Membership Level Select
Tag COVID-19
Tag Acute Respiratory Distress Syndrome ARDS
Year 2021
aerosolized eoprostenil
oxygenation parameters
coagulation factors
mechanical ventilation
antiplatelet agents


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