Right Ventricular Failure Manifesting in Corona Virus Disease 2019 Acute Respiratory Distress Syndrome: A Call to Transition from Venovenous Extracorporeal Membranous Oxygenation to Right Ventricular Assist Device Extracorporeal Membranous Oxygenation

Abstract

Often labeled the forgotten ventricle, the right ventricle's (RV) importance has been magnified over the last 2 years as providers witnessed how severe acute respiratory syndrome coronavirus 2 infection has a predilection for exacerbating RV failure. Venovenous extracorporeal membranous oxygenation (VV-ECMO) has become a mainstay treatment modality for a select patient population suffering from severe COVID-19 acute respiratory distress syndrome. Concomitant early implementation of a right ventricular assist device with ECMO (RVAD-ECMO) may confer benefit in patient outcomes. The underlying mechanism of RV failure in COVID-19 has a multifactorial etiopathogenesis; nonetheless, clinical evaluation of a patient necessitating RV support remains unchanged. Herein, the authors report the case of a critically ill patient who was transitioned from a conventional VV-ECMO Medtronic Crescent cannula to RVAD-ECMO, with the insertion of the LivaNova ProtekDuo dual-lumen RVAD cannula.

Keywords: COVID-19; ProtekDuo; acute respiratory distress syndrome; extracorporeal membranous oxygenation; right ventricular assist device.

Fig 1

Quadrax-i oxygenator attached to LifeSPARC console with ProtekDuo cannulae seen (left); cannula tip seen entering right PA under fluoroscopy (middle); Echocardiogram image of sepat-D flattening (+McConnell Sign) demanding RVAD (right). PA, pulmonary artery; RVAD, right ventricular assist device.

Fig 2

Severely diffuse dense pulmonary fibrosis secondary to SARS-CoV-2 infection. Left shows Crescent cannula with dual-lumen cannulae seen on patient’s left-side. Right shows ProtekDuo cannula with worsened fibrotic changes with dual- lumen cannulae on patient’s right side. SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.