Abstract
Providing complex therapies such as ECMO during outbreaks of infectious
diseases has singular challenges. The impact of the SARS-CoV-2 pandemic
has implied a mentality change by force of circumstances, and cardiac
surgery has not been stranger to this trend. The need to treat
critically ill patients with an unknown evolution has compelled
cardiovascular surgeons to decide whether or not to implant an ECMO
system, despite the limited scientific evidence available in the context
of COVID-19. To add some confusion, doubts were raised about its
potential deleterious outcome in COVID-19 patients, due to its effect on
lymphocyte counts and interleukin-6 concentrations. The care of the
critically ill patient in a moment of national emergency in Spain took
precedence over those possible formal doubts. The Spanish perspective on
Ventricular Assist Devices during and after the COVID-19 pandemic,
focused on ECMO as a particular case of mechanical circulatory support,
is presented. We address both the challenges posed by the pandemic and
the organizational model established in Spain; changes in ECMO therapy
and some lessons learned for the next outbreaks are also described. It
is not about reinventing the wheel in each country; it is enough to
learn from experience and take advantage of the knowledge generated by
those who have already gone through similar situations in our
environment.