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.