Successful ECMO support for COVID-19-induced severe ARDS in patient after LVAD implantation

Ventricular assist devices are increasingly being used as a bridge to transplant in end stage heart failure patients. The Corona Virus Disease (COVID-19) pandemic had affected millions of people across the world, some of them with rapid progression to profound hypoxemia and development of acute respiratory distress syndrome (ARDS). Extracorporeal life support has been widely used in most severe respiratory failure cases, mostly as a veno-venous extracorporeal membrane oxygenation (ECMO). Right ventricle dysfunction does occur in almost 25% of patients with acute ARDS, and some groups of patients might have an increased risk of developing right ventricle (RV) failure. A case is described that involves a 22-year-old female patient who developed acute respiratory distress syndrome and right ventricle failure due to COVID-19 infection 6 months following left ventricle assist device (LVAD) implantation. The goal was to use a modified ECMO cannulation strategy to support the failing right ventricle and the patient's lungs. This was achieved with percutaneous cannulation of the pulmonary artery as an outflow cannula, while an inflow cannula was inserted into the femoral vein. Following 7 days of support, she was weaned from ECMO, and after an uneventful recovery, she was successfully discharged home. This case report shows that modified extracorporeal membrane oxygenation can be successfully used to support the failing ventricle and damaged lungs leading to full recovery in patients following LVAD implantation with severe ARDS and right ventricle failure.