TIVA for ECMO and VAD

In recent decades, the use of temporary and permanent use of mechanical assist devices is on the rise for patients with end-stage cardiac failure. These support strategies hold inherently different risks in the face of noncardiac critical illness and require multidisciplinary treatment strategies. The main issues with all mechanical devices whether extracorporeal membrane oxygenation (ECMO) or ventricular assist device (VAD), are related to thrombosis, anticoagulation, infection, avoiding hypertension and thus use of intravenous drugs, which requires intense monitoring, to circumvent further renal, ischemic or neurological injury and prevent complication.

Ecmo in covid-19-the diffidence has to be overcome by the intensivists and administrators in 2021

In this phase of a shifting geopolitical order with the risk of China and increasing economic inequalities across the globe, there is confusion in understanding the economic recession.The pandemic has revealed one of the weakest links in the health system, that is, the institutional neglect of public district hospitals.We are now hopefully seeing a declining trend in the second wave of the pandemic in India.This is the most appropriate time to identify and plug the existing gaps on our health systems.We must act now to shore up our resources in all technologies to combat the COVID-19 virus with all forms of precaution at the local level and expertise of advanced technologies like mechanic ventilatory support to the failing lungs and heart in the form of extracorporeal membrane oxygenation (ECMO).The latter can be the foun- dation for a functioning and effective health in the inten- sive care unit (ICU) system.Guidelines and expertise from across the borders globally is the need of the hour.After the COVID pandemic dies down, it is the district hospitals and their infrastructure which should be strengthened by way of upgrading public health systems.

Cardiac Echocardiography in COVID-19 Infection

The novel COVID-19 disease mainly affects respiratory organs;however, involvement of cardiovascular system is also not uncommon. Cardiac involvement can manifest as myocarditis, heart failure, myocardial infarction, pulmonary embolism, or arrhythmias in COVID-19 patients. This novel Coronavirus enters into the cells of the human body by binding to ACE-2 receptors which are predominantly present on pneumocytes and cardiomyocytes. The damage to myocardium is manifested by the increase in cardiac enzymes such as troponin-I, CK-MB, and NT pro-BNP. Although echocardiogram is an important tool in the cardiac evaluation of COVID-19 patients, its indiscriminate use is discouraged, owing to the risk of transmission to echocardiography service providers, as well as possible risk of contaminating echocardiography equipment. In this article, we discuss the different mechanisms and cardiac manifestations of COVID-19. We also review the current guidelines for echocardiography evaluation of COVID-19 patients as well as current recommendations on safety of echocardiography personnel and equipment against contamination. We also include our experience of two cases in which COVID-19 affliction of heart was strongly suspected, and echocardiography clinched the diagnosis.

COVID-19 ECMO Myths Busted

Literature has proven that COVID-19 patients develop pneumonia. Prognosis of this is poor in case of COVID-19 patients developing the following: low lymphocyte count (< 16%) which gets lower with active COVID-19 infection, sedentary lifestyle, obesity, and uncontrolled diabetes mellitus with no exercise. A lot of dilemmas and myths in this nascent COVID-19 pandemic period exist regarding the use of ECMO. Perplexities such as do we treat the COVID-19 patients on ECMO, as a pulmonary ARDS pneumonia, and/or do we need high PEEP or moderate PEEP, during ECMO for this ARDS;are some common COVID-19 ECMO myths which this short review aims to cover in a question-answer format.