Introduction
Current knowledge on the use of extracorporeal membrane oxygenation for patients with severe refractory respiratory, cardiac and cardiopulmonary failure associated with COVID-19 is limited to case reports and small observational case series [1]. The clinical presentation of myocarditis associated with COVID-19 is variable, and fulminant myocarditis is usually associated with ventricular arrhythmias and heart failure within 2-3 weeks of contracting SARS-CoV-2 [2]. Early signs may resemble those of septic shock, with tachycardia, pyrexia, hypotension and mottled peripheries [3]. Little is known about how severe cases should be managed, and the role mechanical circulatory support should play is unclear [4,5].
On the one hand, patients with fulminant myocarditis and cardiopulmonary failure will likely not survive without a high-level intervention such as venoarterial extracorporeal membrane oxygenation (VA-ECMO) or biventricular assist device (BiVAD) implantation. Nevertheless, such interventions remain a controversial area of practice due to unresolved questions about: patient selection; the balance of benefit and risk; and the distributive justice of resources [6]. We present the first case of a COVID-19 patient who presented to our institution with profound cardiopulmonary failure who was resuscitated and managed successfully to explant and recovery with a BIVAD as well as an extracorporeal membrane oxygenator.