Saving critically ill COVID-19 patients with mechanical circulatory support.

Area of Science:

• Critical Care Medicine
• Cardiology
• Infectious Diseases

Background:

• COVID-19 has caused widespread mortality due to multiple organ dysfunction syndromes (MODS).
• Critically ill COVID-19 patients often require advanced life support.
• Mechanical circulatory support (MCS) offers a potential lifeline for these patients.

Purpose of the Study:

• To describe the clinical characteristics, management, and outcomes of critically ill COVID-19 patients treated with MCS.
• To identify predictors of survival in COVID-19 patients undergoing MCS.

Main Methods:

• A cohort of 25 critically ill COVID-19 patients who received MCS was studied.
• Data collected included clinical characteristics, laboratory values, and treatment details.
• Cox proportional hazards regression was used to analyze survival determinants.

Main Results:

• 52% of patients (13/25) survived with MCS support.
• Significant differences in peak cardiac troponin I (cTnI), interleukin-6 (IL-6), lymphocyte count, and C-reactive protein (CRP) were observed between survivors and non-survivors.
• Renal replacement therapy (RRT) was associated with a ~20-fold improvement in survival (HR=0.049).
• Extracorporeal membrane oxygenation (ECMO) duration and pH levels correlated positively with survival.
• High-sensitivity C-reactive protein (hs-CRP) and lactate levels were associated with decreased survival.
• Elevated IL-6, IL-8, and TNF-α levels were significantly higher in non-survivors.

Conclusions:

• pH, lactate, hs-CRP, ECMO duration, and RRT are crucial clinical determinants for survival in critically ill COVID-19 patients on MCS.
• These factors can aid in assessing the efficacy of MCS and guiding treatment strategies.
• Further research is warranted to optimize MCS management for COVID-19 patients.