Risk factors influence the arterial line patency in ICU-bound patients during COVID-19 pandemic: An observational cohort study

Abstract

Background There were increased claims of thrombotic events in ICU-bound patients with COVID-19. We designed this observational study to examine implementation of systemic anti-coagulation on arterial catheter patency and its failure and to identify risk factors for arterial catheter failure. Methods A total of 245 COVID-19 subjects were included in this observational study, 48 patients in the non-systemic, (Non-SA), (Prophylactic) anticoagulation cohort, and 197 patients in the systemic (SA), (Therapeutic) anticoagulation group. The first arterial line inserted on ICU admission for every patient was monitored regarding its duration of the patency, number and location of consecutive arterial lines inserted during stay in ICU. Demographics of patients, ICU parameters and risk factors for arterial line failure were followed and analyzed. Results The percentage of arterial line failure was significantly higher in Non-SA group, 45.8% when compared to SA group, 25.9%, P = 0.007. The patients with arterial line failure exhibited higher D-dimer, co-morbidities, diabetic patients, received aspirin and mortality than the patent group, respectively, p = 0.002, p = 0.002, p < 0.0001, p < 0.0001, and p < 0.0001. This group also received higher sedation and prone position on mechanical ventilation and higher vasopressors, respectively, p = 0.034, p < 0.0001, p < 0.0001, and p < 0.0001 when compared to patent group. They had prolonged length of stay in ICU and hospital, respectively, p = 0.001 and p = 0.042. The cumulative incidence of index arterial line failure (Log-rank test 6.95, P = 0.008) with overall percentage was significantly lower in SA group (25.9%) compared to non-SA group (45.8%), respectively, P = 0.007. On Cox-proportional hazard multivariate regression analysis, independent predictors of arterial line failure increased platelets level (HR 1.00, 95% CI 1.00-1.01, P = 0.001), use of ultrasound use in arterial line insertion (HR 4.68, 95% CI 1.75-12.56, P = 0.002), and prone position in ICU (HR 1.94, 95% CI 1.09-3.42, P = 0.023). Conclusion We observed three independent predictors of arterial line failure including platelets level and ultrasound use during arterial catheter insertion and prone position in ICU. Systemic anticoagulation was associated with more patency of arterial catheter than prophylactic therapy group.