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

8 Citations (Web of Science)


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 languageEnglish
Pages (from-to)1249-1267
Number of pages19
JournalArtificial Organs
Issue number7
Early online date1 May 2022
Publication statusPublished - Jul 2022


  • COVID-19
  • extra-corporeal membrane oxygenation
  • extracorporeal life support
  • mechanical circulatory support
  • ECMO
  • 1ST

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