Profiling endogenous adrenal function during veno-venous ECMO support in COVID-19 ARDS: a descriptive analysis

Area of Science:

• Intensive care medicine
• Endocrinology
• Respiratory medicine

Background:

• Prolonged critical illness can impair adrenal function, a condition known as critical illness-related corticosteroid insufficiency (CIRCI).
• Hypoxia is a suspected contributor to CIRCI pathogenesis, particularly in severe acute respiratory distress syndrome (ARDS).
• Data on CIRCI during extracorporeal membrane oxygenation (ECMO) for ARDS are limited.

Purpose of the Study:

• To investigate adrenal function parameters in patients with COVID-19 ARDS undergoing veno-venous (vv)ECMO.
• To assess the behavior of cortisol, aldosterone, and angiotensin metabolites during vvECMO support.
• To explore correlations between cortisol levels and disease severity markers.

Main Methods:

• Retrospective analysis of 11 COVID-19 ARDS patients on vvECMO without corticosteroid therapy.
• Serum concentrations of cortisol, aldosterone, and angiotensin metabolites measured via liquid chromatography/tandem mass spectrometry.
• Measurements taken before, and at 1 day, 1 week, and 2 weeks during vvECMO support.

Main Results:

• Cortisol levels were lowest upon ECMO initiation, progressively increasing over time.
• Higher cortisol concentrations correlated with disease severity markers like IL-6, procalcitonin, pH, base excess, and albumin on day 1.
• Angiotensin metabolite data suggested a homogenous aldosterone response after 1 week of ECMO.

Conclusions:

• Veno-venous ECMO may facilitate partial recovery of adrenal function in critically ill ARDS patients.
• Further research in homogenous patient groups can clarify the role of adrenal stress response in ECMO and its impact on CIRCI.