Con: Venoarterial ECMO Should Not Be Considered in Patients With COVID-19

McLean, Duncan; Henry, Mark

doi:10.1053/j.jvca.2020.11.029

Cited by 5 publications

(10 citation statements)

References 47 publications

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“…Right ventricular dysfunction due to severe respiratory failure commonly causes late cardiovascular collapse in COVID‐19 and constitutes end‐stage disease which is unmanageable with mechanical circulatory support. Thus, mechanical circulatory support with venoarterial extracorporeal membrane oxygenation (VA‐ECMO) is contraindicated in most patients with COVID‐19 due to the presence of multiorgan dysfunction and is extremely resource‐intensive 15 …”

Section: Methodsmentioning

confidence: 99%

Exploring the impact of the COVID‐19 pandemic on cardiac surgical services: A scoping review

Shah

Zafar

Yasmin

et al. 2021

Journal of Cardiac Surgery

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Cardiac surgery was severely affected by the COVID‐19 pandemic. Reallocation of resources, conversion of surgical intensive care units and wards to COVID‐19 facilities, increased risk of nosocomial transmission to cardiac surgery patients, lead to reduced accessibility, quality, and affordability of health care facilities to cardiac surgery patients. Increasing the mortality and morbidity rate among such patients. Cardiac patients are at an increased risk to develop a severe illness if infected by COVID‐19 and are associated with a high mortality rate. Therefore, measures had to be taken to reduce the spread of the virus. Various approaches such as the hubs and the spokes centers, or parallel system were enforced. Elective surgeries were postponed while urgent surgeries were prioritized. Use of personal protective equipments and surgeries performed by only senior surgeons became necessary. Surgical trainees were also affected as limited training opportunities deprived them of the experience required to complete their fellowship. Some of the trainees were reallocated to COVID‐19 wards, while others invested their time in research opportunities. Online platforms were used for teaching, meetings, and workshops across the globe. Although some efforts have been made to reduce the impact of the pandemic, more research and innovation is required.

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Section: Methodsmentioning

confidence: 99%

Exploring the impact of the COVID‐19 pandemic on cardiac surgical services: A scoping review

Shah

Zafar

Yasmin

et al. 2021

Journal of Cardiac Surgery

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“…It is thought that the interaction between host defense mechanism and coagulation system during COVID-19 infection may lead to hypercoagulability and a high prevalence of thrombotic events[ 54 - 56 ]. This finding is reinforced by an elevated D-dimer level which is often present in the setting of COVID-19 infection[ 5 , 55 ]. The combination of endothelial dysfunction, inflammatory state, oxidative stress and platelet activation are thought to be responsible for a hypercoagulable state[ 1 , 5 , 55 ].…”

Section: Coagulopathy In the Worsening Heart During Covid-19mentioning

confidence: 99%

“…This finding is reinforced by an elevated D-dimer level which is often present in the setting of COVID-19 infection[ 5 , 55 ]. The combination of endothelial dysfunction, inflammatory state, oxidative stress and platelet activation are thought to be responsible for a hypercoagulable state[ 1 , 5 , 55 ]. The true nature of the course is remain unknown to date, however the role of endothelial activation cannot be overlooked.…”

Section: Coagulopathy In the Worsening Heart During Covid-19mentioning

confidence: 99%

“…AT interacts with heparin-like glycosaminoglycan (GAG) on endothelial surface and therefore involved in the release of prostacyclin which will inhibit leukocyte activation by decreasing IL-6 Level[ 57 , 59 ]. The hypercoagulability state is also involved in the development of both micro- and macrovascular thrombus and may also plugs the extracorporeal circuits[ 5 , 55 ]. Grave consequence of thrombosis may occur in COVID-19 patients as it may present as pulmonary venous thrombosis leading to right heart failure and or microvascular thrombosis may leads to myocardial dysfunction, worsening the heart function[ 5 , 55 , 60 - 62 ].…”

Section: Coagulopathy In the Worsening Heart During Covid-19mentioning

confidence: 99%

“…COVID-19 is also associated with higher incidence of cardiovascular complication in compare to previous coronavirus outbreaks[ 4 , 5 ]. Deterioration of the cardiac function is prominent in COVID-19 and those with lower baseline function are prone to further decline in cardiac function.…”

Section: Introductionmentioning

confidence: 99%

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In-depth review of cardiopulmonary support in COVID-19 patients with heart failure

Raffaello

Huang

Siswanto

et al. 2021

WJC

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Coronavirus disease 2019 infection has spread worldwide and causing massive burden to our healthcare system. Recent studies show multiorgan involvement during infection, with direct insult to the heart. Worsening of the heart function serves as a predictor of an adverse outcome. This finding raises a particular concern in high risk population, such as those with history of preexisting heart failure with or without implantable device. Lower baseline and different clinical characteristic might raise some challenge in managing either exacerbation or new onset heart failure that might occur as a consequence of the infection. A close look of the inflammatory markers gives an invaluable clue in managing this condition. Rapid deterioration might occur anytime in this setting and the need of cardiopulmonary support seems inevitable. However, the use of cardiopulmonary support in this patient is not without risk. Severe inflammatory response triggered by the infection in combination with the preexisting condition of the worsening heart and implantable device might cause a hypercoagulability state that should not be overlooked. Moreover, careful selection and consideration have to be met before selecting cardiopulmonary support as a last resort due to limited resource and personnel. By knowing the nature of the disease, the interaction between the inflammatory response and different baseline profile in heart failure patient might help clinician to salvage and preserve the remaining function of the heart.

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Characteristics and Outcomes of COVID-19 Patients Supported by Venoarterial or Veno-Arterial-Venous Extracorporeal Membrane Oxygenation

Haroun

Patel

Sims

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Con: Venoarterial ECMO Should Not Be Considered in Patients With COVID-19

Cited by 5 publications

References 47 publications

Exploring the impact of the COVID‐19 pandemic on cardiac surgical services: A scoping review

Exploring the impact of the COVID‐19 pandemic on cardiac surgical services: A scoping review

In-depth review of cardiopulmonary support in COVID-19 patients with heart failure

Characteristics and Outcomes of COVID-19 Patients Supported by Venoarterial or Veno-Arterial-Venous Extracorporeal Membrane Oxygenation

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