MSS 2020 FALL ePOSTER
VAV ECMO IN A COVID-19 PATIENT WITH ACUTE CORONARY SYNDROME
F Alwan, J Wothe, Z Bergman, M Brunsvold
University of Minnesota
Poster Presenter: Fatima Alwan, MS
University of Minnesota
Introduction/Objective: The emergence of the novel coronavirus (SARS-CoV-2) and the global pandemic that ensued has created new challenges in the healthcare landscape, as COVID-19 patients present with many unique constellations of symptoms. The most severe presentations of COVID-19 infections progress to Acute Respiratory Distress Syndrome (ARDS) and require mechanical ventilation. In a growing number of cases, standard medical interventions have been insufficient for ARDS treatment in COVID-19 patients and the use of Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) was necessary. In addition to severe respiratory symptoms, COVID-19 can manifest with an acute cardiovascular syndrome, which has been described as a myocarditis-like syndrome causing acute myocardial injury and reduced left ventricular ejection fraction (Hendren et al). This acute cardiovascular syndrome can be further complicated by arrhythmias, heart failure, and shock (Hendren). The management of ARDS and concomitant cardiovascular complications is not well established – one strategy is veno-arterio-venous (VAV) ECMO. We present a case that demonstrates the role of VAV ECMO in severe ARDS with acute coronary syndrome in COVID-19 infection.
Case Presentation: The patient was a 29-year-old male smoker with a history of obesity (body mass index 41.9), Type-2 diabetes mellitus, and depressive disorder who developed a dry cough. After three days of worsening symptoms and the development of a fever, he presented to an outside clinic for COVID-19 testing, in which he was found positive. In addition to his symptoms persisting, he developed progressively worsening chest pain and was found to have an anterior STEMI and underwent emergent thrombectomy, and then underwent percutaneous coronary intervention.
The patient was transferred to the ICU floor, and upon arrival, became progressively tachypneic and short of breath. Transthoracic echocardiogram showed a possible clot in the left ventricle. As his condition deteriorated further, he was intubated and unfortunately went into cardiac arrest. He underwent intermittent CPR for approximately three hours and was put on VAV ECMO for five days, and then transferred to rehabilitation.
Discussion: Patients with more severe presentations of COVID-19 develop respiratory failure and are subsequently placed on venovenous (VV) ECMO when they require high levels of support. Thus, many of the studies that describe the treatment of patients with COVID do not discuss considerations for use of veno-arterial (VA) ECMO in these patients. However, VV may not be sufficient for patients with concomitant cardiovascular
compromise. Patients who develop cardiovascular sequelae after their respiratory symptoms have resolved may not need respiratory support at all. In this report, we detailed the care of a young patient who required VA ECMO following an anterior STEMI that occurred shortly after recovering from COVID-19.
Conclusion: Our case emphasizes a few important considerations. COVID-19 is often characterized as a disease of aging, however increasing evidence demonstrates the vulnerability of young patients to some of its most severe complications. Our patient’s STEMI occurred 12 days after he was discharged from the hospital, where he only received supplemental oxygen and was never intubated. This differs from many patients who experience these acute events while still hospitalized. This underscores the importance of continued vigilance and monitoring in patients who have recovered from the virus. As physicians and policymakers plan for ongoing COVID-19 disease burden, they must account for additional resources that will be required to care for patients with complications from the disease.
- Author(s) F Alwan, J Wothe, Z Bergman, M Brunsvold
- Program University of Minnesota
- Category Critical Care | Clinical Science
- Presentation Type ePoster