COVID-19 and ECMO: the interplay between coagulation and inflammation—a narrative review

Abstract

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has presently become a rapidly spreading and devastating global pandemic. Veno-venous extracorporeal membrane oxygenation (V-V ECMO) may serve as life-saving rescue therapy for refractory respiratory failure in the setting of acute respiratory compromise such as that induced by SARS-CoV-2. While still little is known on the true efficacy of ECMO in this setting, the natural resemblance of seasonal influenza's characteristics with respect to acute onset, initial symptoms, and some complications prompt to ECMO implantation in most severe, pulmonary decompensated patients. The present review summarizes the evidence on ECMO management of severe ARDS in light of recent COVID-19 pandemic, at the same time focusing on differences and similarities between SARS-CoV-2 and ECMO in terms of hematological and inflammatory interplay when these two settings merge.

Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study

“…Laboratory evidence of coagulopathy was also rare during the SARS-CoV-1 outbreak in 2002 [33]. In contrast, haemorrhage has been frequently reported with other viral infections such as Ebola [34], where organ damage is predominantly in the liver and peripheral vascular beds, which suggests the dominance of either bleeding or thrombosis depends on the causal virus. Therefore, whether our findings represent a true increase in bleeding risk directly due to immune mechanisms related to COVID-19, anticoagulation or are as a result of illness severity remains unclear.…”

EP-7041, a Factor XIa Inhibitor as a Potential Antithrombotic Strategy in Extracorporeal Membrane Oxygenation: A Brief Report

“…The use of extracorporeal membrane oxygenation (ECMO) has greatly expanded over the past 20 years and is expected to continue to rise, perhaps supported by increased use during the coronavirus disease 2019 pandemic ( 1 ). This marked increase has been attributed to a number of factors, including technological advances, more aggressive interventional care in acute cardiovascular deterioration, and growth and acceptance of cardiovascular/cardiopulmonary bridge technologies ( 2 ).…”

Management of valvular and structural heart diseases during the coronavirus disease 2019 pandemic: an expert opinion of the Working Group on Valvular Heart Diseases, the Working Group on Cardiac Surgery, and the Association of Cardiovascular Interventions of the Polish Cardiac Society

“…Pulmonary or cardiac disease, diabetes, hypertension, and obesity are the risk factors for unfavorable outcomes. 2 Obviously, patients with valvular heart disease (VHD) are also included in this risk group.…”