The Annals of thoracic surgery
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A life-threatening complication of coronavirus disease 2019 (COVID-19) is acute respiratory distress syndrome (ARDS) refractory to conventional management. Venovenous (VV) extracorporeal membrane oxygenation (ECMO) (VV-ECMO) is used to support patients with ARDS in whom conventional management fails. Scoring systems to predict mortality in VV-ECMO remain unvalidated in COVID-19 ARDS. This report describes a large single-center experience with VV-ECMO in COVID-19 and assesses the utility of standard risk calculators. ⋯ These results suggest that favorable outcomes are possible in patients with COVID-19 who undergo ECMO at high-volume centers. This study demonstrated an association between the PRESET-Score and survival in patients with COVID-19 who underwent VV-ECMO. Standard risk calculators may aid in appropriate selection of patients with COVID-19 ARDS for ECMO.
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Continuous flow left ventricular assist device(CF-LVAD) support is a mainstay in the hemodynamic management of patients with end-stage heart failure refractory to optimal medical therapy. In this report, we evaluated waitlist complications and competing outcomes for CF-LVAD patients compared to primary transplant candidates listed for orthotopic heart transplantation(OHT) at a single center. ⋯ While device related-complications were significantly associated with decreased rates of transplant, CF-LVAD patients had excellent waitlist outcomes overall. In light of the 2018 allocation score change, the risk of complications should be taken into account when deciding whether to offer CF-LVAD as a bridge to transplant.
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Management of acute type A aortic dissection (AADA) presenting with cardiopulmonary arrest (CPA) may require aggressive cardiopulmonary resuscitation (CPR), including extracorporeal CPR followed by aortic repair. This study evaluated the early and long-term outcomes of patients with preoperative CPA related to AADA. ⋯ AADA with CPA is associated with significantly high mortality; however aortic repair can be performed with a 30% likelihood of functional recovery, if return of spontaneous circulation is achieved. Preoperative extracorporeal membrane oxygenation is not recommended in this patient cohort.