Chow Justin, Alhussaini Anhar, Calvillo-Argüelles Oscar, Billia Filio, Luk Adriana
Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
CJC Open. 2020 Apr 8;2(4):273-277. doi: 10.1016/j.cjco.2020.04.003. eCollection 2020 Jul.
Coronavirus Disease 2019 (COVID-19) has been associated with cardiovascular complications, including acute cardiac injury, heart failure, and cardiogenic shock (CS). The role of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the event of COVID-19-associated cardiovascular collapse has not been established. We reviewed the existing literature surrounding the role of VA-ECMO in the treatment of coronavirus-related cardiovascular collapse. COVID-19 is associated with a higher incidence of cardiovascular complications compared with previous coronavirus outbreaks (Severe Acute Respiratory Syndrome Coronavirus and Middle East Respiratory Syndrome Coronavirus). We found only 1 case report from China in which COVID-19-associated fulminant myocarditis and CS were successfully rescued using VA-ECMO as a bridge to recovery. We identified potential clinical scenarios (cardiac injury, myocardial infarction with and without obstructive coronary artery disease, viral myocarditis, and decompensated heart failure) leading to CS and risk factors for poor/uncertain benefit (age, sepsis, mixed/predominantly vasodilatory shock, prothrombotic state or coagulopathy, severe acute respiratory distress syndrome, multiorgan failure, or high-risk prognostic scores) specific to using VA-ECMO as a bridge to recovery in COVID-19 infection. Additional considerations and proposed recommendations specific to the COVID-19 pandemic were formulated with guidance from published data and expert consensus. A small subset of patients with cardiovascular complications from COVID-19 infection may progress to refractory CS. While accepting that resource scarcity may be the overwhelming concern for healthcare systems during this pandemic, VA-ECMO can be considered in highly selected cases of refractory CS and echocardiographic evidence of biventricular failure. The decision to initiate this therapy should take into consideration the availability of resources, perceived benefit, and risks of transmitting disease.
2019冠状病毒病（COVID-19）与心血管并发症有关，包括急性心脏损伤、心力衰竭和心源性休克（CS）。静脉-动脉体外膜肺氧合（VA-ECMO）在COVID-19相关心血管衰竭情况下的作用尚未明确。我们回顾了关于VA-ECMO在治疗冠状病毒相关心血管衰竭中作用的现有文献。与之前的冠状病毒爆发（严重急性呼吸综合征冠状病毒和中东呼吸综合征冠状病毒）相比，COVID-19相关心血管并发症的发生率更高。我们仅在中国发现1例病例报告，其中使用VA-ECMO作为恢复桥梁成功救治了COVID-19相关暴发性心肌炎和CS患者。我们确定了导致CS的潜在临床情况（心脏损伤、有无阻塞性冠状动脉疾病的心肌梗死、病毒性心肌炎和失代偿性心力衰竭）以及在COVID-19感染中使用VA-ECMO作为恢复桥梁的不良/获益不确定的危险因素（年龄、脓毒症、混合性/以血管舒张性休克为主、血栓前状态或凝血病、严重急性呼吸窘迫综合征、多器官衰竭或高风险预后评分）。根据已发表的数据和专家共识，制定了针对COVID-19大流行的其他注意事项和建议。一小部分COVID-19感染所致心血管并发症患者可能进展为难治性CS。虽然承认在此次大流行期间资源稀缺可能是医疗系统最主要的担忧，但在高度选择的难治性CS病例且有双心室衰竭超声心动图证据的情况下，可以考虑使用VA-ECMO。启动这种治疗的决定应考虑资源的可用性、预期获益以及传播疾病的风险。
