COVID-19 and ECMO: the interplay between coagulation and inflammation—a narrative review
Mariusz Kowalewski,
Dario Fina,
Artur Słomka,
Giuseppe Maria Raffa,
Gennaro Martucci,
Valeria Lo Coco,
Maria Elena De Piero,
Marco Ranucci,
Piotr Suwalski,
Roberto Lorusso
Affiliations
Mariusz Kowalewski
Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education
Dario Fina
Cardio-Thoracic Surgery Department Heart and Vascular Centre, Maastricht University Medical Centre
Artur Słomka
Chair and Department of Pathophysiology Nicolaus Copernicus University, Collegium Medicum
Giuseppe Maria Raffa
Cardiac Surgery Unit, IRCCS-ISMETT
Gennaro Martucci
Anesthesia and Intensive Care Department, IRCCS-ISMETT
Valeria Lo Coco
Cardio-Thoracic Surgery Department Heart and Vascular Centre, Maastricht University Medical Centre
Maria Elena De Piero
Cardio-Thoracic Surgery Department Heart and Vascular Centre, Maastricht University Medical Centre
Marco Ranucci
Department of Cardiovascular Anesthesia and ICU, IRCCS Policlinico San Donato
Piotr Suwalski
Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education
Roberto Lorusso
Cardio-Thoracic Surgery Department Heart and Vascular Centre, Maastricht University Medical Centre
Abstract Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has presently become a rapidly spreading and devastating global pandemic. Veno-venous extracorporeal membrane oxygenation (V-V ECMO) may serve as life-saving rescue therapy for refractory respiratory failure in the setting of acute respiratory compromise such as that induced by SARS-CoV-2. While still little is known on the true efficacy of ECMO in this setting, the natural resemblance of seasonal influenza’s characteristics with respect to acute onset, initial symptoms, and some complications prompt to ECMO implantation in most severe, pulmonary decompensated patients. The present review summarizes the evidence on ECMO management of severe ARDS in light of recent COVID-19 pandemic, at the same time focusing on differences and similarities between SARS-CoV-2 and ECMO in terms of hematological and inflammatory interplay when these two settings merge.
