Temporary mechanical circulatory support for COVID-19 patients: A systematic review of literature

Silvia Mariani; Maria Elena De Piero; Justine M Ravaux; Alexander Saelmans; Michal J Kawczynski; Bas C T van Bussel; Michele Di Mauro; Anne Willers; Justyna Swol; Mariusz Kowalewski; Tong Li; Thijs S R Delnoij; Iwan C C van der Horst; Jos Maessen; Roberto Lorusso

doi:10.1111/aor.14261

Temporary mechanical circulatory support for COVID-19 patients: A systematic review of literature

Silvia Mariani^*, Maria Elena De Piero, Justine M Ravaux, Alexander Saelmans, Michal J Kawczynski, Bas C T van Bussel, Michele Di Mauro, Anne Willers, Justyna Swol, Mariusz Kowalewski, Tong Li, Thijs S R Delnoij, Iwan C C van der Horst, Jos Maessen, Roberto Lorusso

^*Corresponding author for this work

Research output: Contribution to journal › (Systematic) Review article › peer-review

Abstract

OBJECTIVE: Myocardial damage occurs in up to 25% of coronavirus disease 2019 (COVID-19) cases. While veno-venous extracorporeal life support (V-V ECLS) is used as respiratory support, mechanical circulatory support (MCS) may be required for severe cardiac dysfunction. This systematic review summarizes the available literature regarding MCS use rates, disease drivers for MCS initiation, and MCS outcomes in COVID-19 patients.

METHODS: PubMed/EMBASE were searched until October 14, 2021. Articles including adults receiving ECLS for COVID-19 were included. The primary outcome was the rate of MCS use. Secondary outcomes included mortality at follow-up, ECLS conversion rate, intubation-to-cannulation time, time on ECLS, cardiac diseases, use of inotropes, and vasopressors.

RESULTS: Twenty-eight observational studies (comprising both ECLS-only populations and ECLS patients as part of larger populations) included 4218 COVID-19 patients (females: 28.8%; median age: 54.3 years, 95%CI: 50.7-57.8) of whom 2774 (65.8%) required ECLS with the majority (92.7%) on V-V ECLS, 4.7% on veno-arterial ECLS and/or Impella, and 2.6% on other ECLS. Acute heart failure, cardiogenic shock, and cardiac arrest were reported in 7.8%, 9.7%, and 6.6% of patients, respectively. Vasopressors were used in 37.2%. Overall, 3.1% of patients required an ECLS change from V-V ECLS to MCS for heart failure, myocarditis, or myocardial infarction. The median ECLS duration was 15.9 days (95%CI: 13.9-16.3), with an overall survival of 54.6% and 28.1% in V-V ECLS and MCS patients. One study reported 61.1% survival with oxy-right ventricular assist device.

CONCLUSION: MCS use for cardiocirculatory compromise has been reported in 7.3% of COVID-19 patients requiring ECLS, which is a lower percentage compared to the incidence of any severe cardiocirculatory complication. Based on the poor survival rates, further investigations are warranted to establish the most appropriated indications and timing for MCS in COVID-19.

Original language	English
Pages (from-to)	1249-1267
Number of pages	19
Journal	Artificial Organs
Volume	46
Issue number	7
Early online date	1 May 2022
DOIs	https://doi.org/10.1111/aor.14261
Publication status	Published - Jul 2022

Keywords

COVID-19
extra-corporeal membrane oxygenation
extracorporeal life support
mechanical circulatory support
ECMO
PULMONARY
CRITICALLY-ILL
TRENDS
SOCIETY
1ST
LIFE-SUPPORT
VENTRICULAR ASSIST DEVICE
OUTCOMES
EXTRACORPOREAL MEMBRANE-OXYGENATION

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Cite this

Mariani, S., De Piero, M. E., Ravaux, J. M., Saelmans, A., Kawczynski, M. J., van Bussel, B. C. T., Di Mauro, M., Willers, A., Swol, J., Kowalewski, M., Li, T., Delnoij, T. S. R., van der Horst, I. C. C., Maessen, J., & Lorusso, R. (2022). Temporary mechanical circulatory support for COVID-19 patients: A systematic review of literature. Artificial Organs, 46(7), 1249-1267. https://doi.org/10.1111/aor.14261

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title = "Temporary mechanical circulatory support for COVID-19 patients: A systematic review of literature",

abstract = "OBJECTIVE: Myocardial damage occurs in up to 25% of coronavirus disease 2019 (COVID-19) cases. While veno-venous extracorporeal life support (V-V ECLS) is used as respiratory support, mechanical circulatory support (MCS) may be required for severe cardiac dysfunction. This systematic review summarizes the available literature regarding MCS use rates, disease drivers for MCS initiation, and MCS outcomes in COVID-19 patients.METHODS: PubMed/EMBASE were searched until October 14, 2021. Articles including adults receiving ECLS for COVID-19 were included. The primary outcome was the rate of MCS use. Secondary outcomes included mortality at follow-up, ECLS conversion rate, intubation-to-cannulation time, time on ECLS, cardiac diseases, use of inotropes, and vasopressors.RESULTS: Twenty-eight observational studies (comprising both ECLS-only populations and ECLS patients as part of larger populations) included 4218 COVID-19 patients (females: 28.8%; median age: 54.3 years, 95%CI: 50.7-57.8) of whom 2774 (65.8%) required ECLS with the majority (92.7%) on V-V ECLS, 4.7% on veno-arterial ECLS and/or Impella, and 2.6% on other ECLS. Acute heart failure, cardiogenic shock, and cardiac arrest were reported in 7.8%, 9.7%, and 6.6% of patients, respectively. Vasopressors were used in 37.2%. Overall, 3.1% of patients required an ECLS change from V-V ECLS to MCS for heart failure, myocarditis, or myocardial infarction. The median ECLS duration was 15.9 days (95%CI: 13.9-16.3), with an overall survival of 54.6% and 28.1% in V-V ECLS and MCS patients. One study reported 61.1% survival with oxy-right ventricular assist device.CONCLUSION: MCS use for cardiocirculatory compromise has been reported in 7.3% of COVID-19 patients requiring ECLS, which is a lower percentage compared to the incidence of any severe cardiocirculatory complication. Based on the poor survival rates, further investigations are warranted to establish the most appropriated indications and timing for MCS in COVID-19.",

keywords = "COVID-19, extra-corporeal membrane oxygenation, extracorporeal life support, mechanical circulatory support, ECMO, PULMONARY, CRITICALLY-ILL, TRENDS, SOCIETY, 1ST, LIFE-SUPPORT, VENTRICULAR ASSIST DEVICE, OUTCOMES, EXTRACORPOREAL MEMBRANE-OXYGENATION",

author = "Silvia Mariani and {De Piero}, {Maria Elena} and Ravaux, {Justine M} and Alexander Saelmans and Kawczynski, {Michal J} and {van Bussel}, {Bas C T} and {Di Mauro}, Michele and Anne Willers and Justyna Swol and Mariusz Kowalewski and Tong Li and Delnoij, {Thijs S R} and {van der Horst}, {Iwan C C} and Jos Maessen and Roberto Lorusso",

note = "{\textcopyright} 2022 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.",

year = "2022",

month = jul,

doi = "10.1111/aor.14261",

language = "English",

volume = "46",

pages = "1249--1267",

journal = "Artificial Organs",

issn = "0160-564X",

publisher = "Wiley",

number = "7",

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Mariani, S, De Piero, ME, Ravaux, JM, Saelmans, A, Kawczynski, MJ , van Bussel, BCT , Di Mauro, M , Willers, A, Swol, J, Kowalewski, M, Li, T, Delnoij, TSR , van der Horst, ICC , Maessen, J & Lorusso, R 2022, 'Temporary mechanical circulatory support for COVID-19 patients: A systematic review of literature', Artificial Organs, vol. 46, no. 7, pp. 1249-1267. https://doi.org/10.1111/aor.14261

TY - JOUR

T1 - Temporary mechanical circulatory support for COVID-19 patients

T2 - A systematic review of literature

AU - Mariani, Silvia

AU - De Piero, Maria Elena

AU - Ravaux, Justine M

AU - Saelmans, Alexander

AU - Kawczynski, Michal J

AU - van Bussel, Bas C T

AU - Di Mauro, Michele

AU - Willers, Anne

AU - Swol, Justyna

AU - Kowalewski, Mariusz

AU - Li, Tong

AU - Delnoij, Thijs S R

AU - van der Horst, Iwan C C

AU - Maessen, Jos

AU - Lorusso, Roberto

PY - 2022/7

Y1 - 2022/7

N2 - OBJECTIVE: Myocardial damage occurs in up to 25% of coronavirus disease 2019 (COVID-19) cases. While veno-venous extracorporeal life support (V-V ECLS) is used as respiratory support, mechanical circulatory support (MCS) may be required for severe cardiac dysfunction. This systematic review summarizes the available literature regarding MCS use rates, disease drivers for MCS initiation, and MCS outcomes in COVID-19 patients.METHODS: PubMed/EMBASE were searched until October 14, 2021. Articles including adults receiving ECLS for COVID-19 were included. The primary outcome was the rate of MCS use. Secondary outcomes included mortality at follow-up, ECLS conversion rate, intubation-to-cannulation time, time on ECLS, cardiac diseases, use of inotropes, and vasopressors.RESULTS: Twenty-eight observational studies (comprising both ECLS-only populations and ECLS patients as part of larger populations) included 4218 COVID-19 patients (females: 28.8%; median age: 54.3 years, 95%CI: 50.7-57.8) of whom 2774 (65.8%) required ECLS with the majority (92.7%) on V-V ECLS, 4.7% on veno-arterial ECLS and/or Impella, and 2.6% on other ECLS. Acute heart failure, cardiogenic shock, and cardiac arrest were reported in 7.8%, 9.7%, and 6.6% of patients, respectively. Vasopressors were used in 37.2%. Overall, 3.1% of patients required an ECLS change from V-V ECLS to MCS for heart failure, myocarditis, or myocardial infarction. The median ECLS duration was 15.9 days (95%CI: 13.9-16.3), with an overall survival of 54.6% and 28.1% in V-V ECLS and MCS patients. One study reported 61.1% survival with oxy-right ventricular assist device.CONCLUSION: MCS use for cardiocirculatory compromise has been reported in 7.3% of COVID-19 patients requiring ECLS, which is a lower percentage compared to the incidence of any severe cardiocirculatory complication. Based on the poor survival rates, further investigations are warranted to establish the most appropriated indications and timing for MCS in COVID-19.

AB - OBJECTIVE: Myocardial damage occurs in up to 25% of coronavirus disease 2019 (COVID-19) cases. While veno-venous extracorporeal life support (V-V ECLS) is used as respiratory support, mechanical circulatory support (MCS) may be required for severe cardiac dysfunction. This systematic review summarizes the available literature regarding MCS use rates, disease drivers for MCS initiation, and MCS outcomes in COVID-19 patients.METHODS: PubMed/EMBASE were searched until October 14, 2021. Articles including adults receiving ECLS for COVID-19 were included. The primary outcome was the rate of MCS use. Secondary outcomes included mortality at follow-up, ECLS conversion rate, intubation-to-cannulation time, time on ECLS, cardiac diseases, use of inotropes, and vasopressors.RESULTS: Twenty-eight observational studies (comprising both ECLS-only populations and ECLS patients as part of larger populations) included 4218 COVID-19 patients (females: 28.8%; median age: 54.3 years, 95%CI: 50.7-57.8) of whom 2774 (65.8%) required ECLS with the majority (92.7%) on V-V ECLS, 4.7% on veno-arterial ECLS and/or Impella, and 2.6% on other ECLS. Acute heart failure, cardiogenic shock, and cardiac arrest were reported in 7.8%, 9.7%, and 6.6% of patients, respectively. Vasopressors were used in 37.2%. Overall, 3.1% of patients required an ECLS change from V-V ECLS to MCS for heart failure, myocarditis, or myocardial infarction. The median ECLS duration was 15.9 days (95%CI: 13.9-16.3), with an overall survival of 54.6% and 28.1% in V-V ECLS and MCS patients. One study reported 61.1% survival with oxy-right ventricular assist device.CONCLUSION: MCS use for cardiocirculatory compromise has been reported in 7.3% of COVID-19 patients requiring ECLS, which is a lower percentage compared to the incidence of any severe cardiocirculatory complication. Based on the poor survival rates, further investigations are warranted to establish the most appropriated indications and timing for MCS in COVID-19.

KW - COVID-19

KW - extra-corporeal membrane oxygenation

KW - extracorporeal life support

KW - mechanical circulatory support

KW - ECMO

KW - PULMONARY

KW - CRITICALLY-ILL

KW - TRENDS

KW - SOCIETY

KW - 1ST

KW - LIFE-SUPPORT

KW - VENTRICULAR ASSIST DEVICE

KW - OUTCOMES

KW - EXTRACORPOREAL MEMBRANE-OXYGENATION

U2 - 10.1111/aor.14261

DO - 10.1111/aor.14261

M3 - (Systematic) Review article

C2 - 35490367

SN - 0160-564X

VL - 46

SP - 1249

EP - 1267

JO - Artificial Organs

JF - Artificial Organs

IS - 7

ER -