ABSTRACT
Objectives: Cases of fulminant myocarditis after mRNA COVID-19 vaccination have been reported. The most severe may need venoarterial extracorporeal membrane oxygenation (V-A ECMO) support. Here we report two cases successfully rescued with V-A ECMO. Method(s): We included all the cases supported with V-A ECMO for refractory cardiogenic shock due to myocarditis secondary to a mRNA SARS-COV2 vaccine in the high-volume adult ECMO Program in Vall Hebron University Hospital since January 2020. Result(s): We identified two cases (table). One of them was admitted for out-of-hospital cardiac arrest. In both, a peripheral V-A ECMO was implanted in the cath lab. An intra-aortic balloon pump was needed in one case for left ventricle unloading. Support could be successfully withdrawn in a mean of five days. No major bleeding or thrombosis complications occurred. Definite microscopic diagnosis could be reached in one case (Image, 3). Treatment was the same, using 1000mg of methylprednisolone/day for 3 days. A cardiac magnetic resonance 10 days after admission showed a significant improvement in systolic function and diffuse oedema and subepicardial contrast intake in different segments (Image, 1-2). Both patients were discharged fully recovered. Conclusion(s): V-A ECMO should be established in cases of COVID-19 vaccine-associated myocarditis with refractory cardiogenic shock during the acute phase. (Table Presented).
ABSTRACT
HEMOCOVID-19 is a multi-center trial aiming to assess the microvascular and endothelial health of severe COVID-19 patients in the intensive care using near-infrared spectroscopy. Here, we present the preliminary results, showing that peripheral microcirculatory alterations are associated with the severity of acute respiratory distress syndrome. © 2022 The Author(s).
ABSTRACT
We present the HEMOCOVID-19 study spanning four countries and eight hospitals where near-infrared spectroscopy is utilized to evaluate microvascular and endothelial health of severe COVID-19 patients at the intensive care. © 2021 SPIE. All rights reserved.
ABSTRACT
Objective: To analyze the complications developed in patients with COVID-19 supported with ECMO and to evaluate their impact in outcomes. Methods: Prospective observational study including all the COVID-19 patients with ECMO support in the ICU of the VHUH from 15 March to 30 July. Infectious, renal, thrombotic, hemorrhagic and other complications during support were prospectively registered. Continuous variables expressed as median (interquartile range) and categorical variables as number (percentage). The impact of complications in mortality was analyzed using Chi-squared or Fisheŕs exact test as appropriate. Results: Twenty-four patients [55 (46-57) years, 58% male, BMI 32.1 (27-35)] received ECMO support [23 (96%) VV-ECMO] during 11 (5.7-19.2) days. The longest run lasted 67 days (awake ECMO). Eighteen (75%) patients could be decannulated and 16 (67%) were discharged alive from the ICU. Fifteen (63%) patients suffered hemorrhagic complications and 12 (48%) thrombotic events, with 7 (29%) patients needing circuit change. Ventilator-associated pneumonia (VAP) was diagnosed in 8 (33%) patients and acute kidney injury (AKI) in 7 (29%). Other complications were air leak (5 patients), fungal infection (4), CMV replication (3) and cardiac tamponade (1). Hemorrhage and thrombosis were not associated with mortality (P=1.0 and P=0.6, respectively). VAP and AKI were neither associated with mortality (P=0.3 both). Conclusions: Complications are frequent in COVID-19 patients supported with ECMO, especially thrombotic and hemorrhagic. VAP and AKI might be studied in further studies to confirm their association with a higher risk of mortality.