The role of mechanical circulatory support in COVID 19 patients

Abstract

The role of mechanical circulatory support in COVID 19 patientsThe onset and impact of coronavirus disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has left dramatic effects on all aspects of life. Social life, economy, and medical care face challenge not seen before. With regard to end-stage heart failure and mechanical circulatory support (MCS), challenges, strategies, and preparations are addressed within this editorial.Indeed, MCS has become a true story of success, particularly following recent innovations in the last decade. Both, durable and temporary devices have changed the way we treat heart failure nowadays remarkably. [1][2][3][4] Nevertheless, the COVID-19 pandemic does not spare MCS at all. Instead, COVID-19 and MCS affect one another in two ways. Since we know that COVID-19 infection is not limited to the respiratory tract, but may also affect the heart, the matter of need for MCS in COVID-19 associated heart failure has arisen. 5 At the same time, the pandemic itself has caused significant limitations and restrictions to medical health systems as never before in modern times. Medical professionals and intensive-care resources have been and are still partially blocked for the treatment of patients suffering from severe COVID-19 infection. The focus of medical treatment altered towards diagnosis and treatment of COVID-19 and yet, the complete impact of the pandemic is unclear. As a result, elective admissions and surgery decreased consecutively and overall discomfiture and uncertainty in patients and healthcare professionals increased at the same time. Hence, outpatient care of permanent left ventricular assist device (LVAD) patients and immediate medical professional staff to patient interaction suffered, too. | COVID-19 AND CARDIAC INVOLVEMENTCOVID-19 is caused by SARS-CoV-2 and implicates the respiratory tract to be the main organ system affected by the virus. Notwithstanding, cardiovascular complications, including heart failure, may affect a large part of patients. [6][7][8] Acute virus-mediated myocardial injury and systemic inflammation may aggravate a pre-existing cardiac condition. Furthermore, reports have been published associating COVID-19 with thromboembolism. 9 However, with the immediate association of mechanical support and infectious disease, the role of MCS in this greater context of COVID-19 needs to be addressed.

Recent Advancements on COVID-19: A Comprehensive Review

“…In cases of severe lung failure, extracorporeal membrane oxygenation (ECMO) is used to re-establish pulmonary gas exchange. 222 The estimated mortality in patients with severe COVID-19 who received ECMO is <40%. 223 …”

“…In COVID-19 patients with heart failure and decreased cardiac output, it is necessary to institute extracorporeal life support (ECLS). 222 …”