Advanced Pulmonary and Cardiac Support of COVID-19 Patients: Emerging Recommendations From ASAIO—A “Living Working Document”

Rajagopal, Keshava; Keller, Steven P.; Akkanti, Bindu; Bime, Christian; Loyalka, Pranav; Cheema, Faisal H.; Zwischenberger, Joseph B.; Banayosy, Aly El; Pappalardo, Federico; Slaughter, Mark S.; Slepian, Marvin J.

doi:10.1097/mat.0000000000001180

Cited by 65 publications

(88 citation statements)

References 72 publications

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“…Treatment of acute respiratory failure of a COVID-19 infection consists of different pulmonary support strategies: non-invasive ventilation, invasive ventilation, prone position and in selective cases venovenous extracorporeal membrane oxygenation (V-V ECMO) [5]. Initial reports on V-V ECMO utilization during COVID-19 respiratory failure have described a hospital mortality of 50% though newer register data reported by the European Extracorporeal Life Support Organization (EuroELSO) seems to be more encouraging with a reported death rate of 17.1% with a great variety between centers [6,7].…”

Section: Introductionmentioning

confidence: 99%

Thrombotic circuit complications during venovenous extracorporeal membrane oxygenation in COVID-19

Bemtgen

Zotzmann

Benk

et al. 2020

J Thromb Thrombolysis

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The novel coronavirus SARS-CoV-2 and the resulting disease COVID-19 causes pulmonary failure including severe courses requiring venovenous extracorporeal membrane oxygenation (V-V ECMO). Coagulopathy is a known complication of COVID-19 leading to thrombotic events including pulmonary embolism. It is unclear if the coagulopathy also increases thrombotic circuit complications of the ECMO. Aim of the present study therefor was to investigate the rate of V-V ECMO complications in COVID-19. We conducted a retrospective registry study including all patients on V-V ECMO treated at our centre between 01/2018 and 04/2020. COVID-19 cases were compared non-COVID-19 cases. All circuit related complications resulting in partial or complete exchange of the extracorporeal system were registered. In total, 66 patients were analysed of which 11 (16.7%) were SARS-CoV-2 positive. The two groups did not differ in clinical parameters including age (COVID-19 59.4 vs. non-COVID-19 58.1 years), gender (36.4% vs. 40%), BMI (27.8 vs. 24.2) and severity of illness as quantified by the RESP Score (1pt. vs 1pt.). 28 days survival was similar in both groups (72.7% vs. 58.2%). While anticoagulation was similar in both groups (p = 0.09), centrifugal pump head thrombosis was more frequent in COVID-19 (9/11 versus 16/55 p < 0.01). Neither the time to first exchange (p = 0.61) nor blood flow at exchange (p = 0.68) did differ in both groups. D-dimer levels prior to the thrombotic events were significantly higher in COVID-19 (mean 15.48 vs 26.59, p = 0.01). The SARS-CoV-2 induced infection is associated with higher rates of thrombotic events of the extracorporeal system during V-V ECMO therapy. Keyword V-V ECMO • COVID-19 • Thrombotic complications • Pump head thrombosis Abbreviations aPTT Activated partial thromboplastin time ARDS Acute respiratory distress syndrome COVID-19 Coronavirus disease 2019 ICU Intensive care unit SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 V-V ECMO Venovenous extracorporeal membrane oxygenation Highlights • This study compared the rate of thrombotic circuit complications in COVID-19 V-V ECMO patients to historical controls. • The two groups were comparable.

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Section: Introductionmentioning

confidence: 99%

Thrombotic circuit complications during venovenous extracorporeal membrane oxygenation in COVID-19

Bemtgen

Zotzmann

Benk

et al. 2020

J Thromb Thrombolysis

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“…As far as cardiogenic shock complicating COVID-19 is concerned, little evidence is offered for the use of VA-ECMO in these patients [44,57]. Given the lack of documented experience, some working groups have proposed general recommendations for the use of this intensive care treatment, focusing attention on the patient's age, the presence of sepsis, the coagulation status, and the presence of ARDS and/or MOF, whose presence can frustrate the use of this device [58,59].…”

Section: Heart Failurementioning

confidence: 99%

COVID-19 and Heart: From Clinical Features to Pharmacological Implications

Russo

Bottino

Carbone

et al. 2020

JCM

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A highly pathogenic human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been recently recognized in Wuhan, China, as the cause of the coronavirus disease 2019 (COVID-19) outbreak which has spread rapidly from China to other countries in the world, causing a pandemic with alarming morbidity and mortality. The emerging epidemiological data about COVID-19 patients suggest an association between cardiovascular diseases (CVD) and SARS-CoV-2 infection, in term of clinical features at hospital admission and prognosis for disease severity. The aim of our review is to describe the cardiological features of COVID-19 patients at admission, the acute cardiac presentation, the clinical outcome for patients with underlying CVD and the pharmacological implications for disease management.

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“…">Patients requiring concomitant cardiac support may be candidates for either veno‐arterial (VA) ECMO or veno‐veno (VV) ECMO and a percutaneous ventricular assist device (ie, Impella CP, Abiomed, Danvers, MA). However, it must be recognized that these patients have been shown to have advanced COVID‐19 disease and the combination of cardiac and pulmonary failure is currently associated with an extremely poor prognosis and may only benefit from advanced mechanical support therapies in highly selected patients 35 …”

Section: Extra‐corporeal Membrane Oxygenation For Covid‐19mentioning

confidence: 99%

Cardiac surgery considerations and lessons learned during the COVID‐19 pandemic

et al. 2020

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The COVID‐19 pandemic has transformed cardiac surgical practices. Limitations in intensive care resources and personal protective equipment have required many practices throughout the globe to pause elective operations and now slowly resume operations. However, much of cardiac surgery is not elective and patients continue to require surgery on an urgent or emergent basis during the pandemic. This continued need for providing surgical services has introduced several unique considerations ranging from how to prioritize surgery, how to ensure safety for cardiac surgical teams, and how best to resume elective operations to ensure the safety of patients. Additionally, the COVID‐19 pandemic has required a careful analysis of how best to carry out heart transplantation, extra‐corporeal membrane oxygenation, and congenital heart surgery. In this review, we present the many areas of multidisciplinary consideration, and the lessons learned that have allowed us to carry out cardiac surgery with excellence during the COVID‐19 pandemic. As various states experience plateaus, declines, and rises in COVID‐19 cases, these considerations are particularly important for cardiac surgical programs throughout the globe.

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Advanced Pulmonary and Cardiac Support of COVID-19 Patients: Emerging Recommendations From ASAIO—A “Living Working Document”

Cited by 65 publications

References 72 publications

Thrombotic circuit complications during venovenous extracorporeal membrane oxygenation in COVID-19

Thrombotic circuit complications during venovenous extracorporeal membrane oxygenation in COVID-19

COVID-19 and Heart: From Clinical Features to Pharmacological Implications

Cardiac surgery considerations and lessons learned during the COVID‐19 pandemic

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