301: Comparison of Inhaled Nitric Oxide and Aerosolized Epoprostenol in Covid-19-Related Ards

Abstract

INTRODUCTION:Previous studies have shown that inhaled pulmonary vasodilators can improve oxygenation in patients with acute respiratory distress syndrome (ARDS). It is unclear whether inhaled nitric oxide (iNO) or aerosolized epoprostenol (aEPO) is superior in patients with ARDS from Coronavirus Disease-2019 (COVID-19). iNO may possess antiviral properties and a small in vitro study demonstrated inhibition of SARS-CoV replication. Patients with COVID-19 are predisposed to venous thromboembolism and aEPO may exert antithrombic effects. The aim of this study was to compare the safety and efficacy of iNO versus aEPO in COVID-19 patients with ARDS. METHODS:This was a single-center, retrospective chart review, which included patients hospitalized with COVID-19 ARDS between March 1, 2020 and March 1, 2021 who were treated with an inhaled pulmonary vasodilator. The primary outcome was mechanical ventilator (MV)-free days and secondary outcomes included in-hospital mortality, intensive care unit (ICU) length of stay (LOS), hospital LOS, initiation of extracorporeal membrane oxygenation (ECMO), and change in plateau pressures at 1, 4, 6, and 12 hours after pulmonary vasodilator initiation. Safety outcomes included incidence of bleeding, methemoglobinemia, and thrombocytopenia.