VA-ECMO and VV-ECMO in COVID-19: Severe ARDS or Cardiogenic Shock?

Abstract

The novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, on December 2019. Since then it has spread worldwide, causing an unforeseen global crisis. Respiratory involvement ranging from a mild flu-like illness to potentially lethal acute respiratory distress syndrome (ARDS) is the predominant clinical manifestation of SARS-CoV-2. However, cardiovascular complications can also result in severe morbidity and mortality. Although ARDS appears to be the most common trigger for intensive care unit (ICU) admission, cardiac injury and shock are also frequent. In patients with ARDS and/or cardiogenic shock, the Extracorporeal Membrane Oxygenation (ECMO) is often required to provide respiratory and cardiac support. Nevertheless, evidence on ECMO in COVID-19 patients remains controversial. This review sought to analyse the use of veno-venous-ECMO and veno-arterial-ECMO in SARS-CoV-2 positive patients, of whom age (p-value 0.89), previous medical history, presenting complaints, echocardiography, indication for ECMO, duration of support (p-value0.31), and status at discharge (mortality p-value0.75) were analysed. It has to be acknowledged that a multidisciplinary approach and a frequent reassessment of response to mechanical circulatory support are fundamental for the SARS-CoV-2 population requiring cardiac and/or respiratory support. Keywords: VA-ECMO;VV-ECMO;ECLS;COVID-19;SARS-CoV-2;cardiogenic shock;ARDS