Rapid Deterioration of Hospital-Acquired COVID-19 in a Patient on Extracorporeal Left Ventricular Assist Support.
Estefania Oliveros, Kiran Mahmood, Maroun Yammine and 8 others
PMID 33010519WHAT IT FOUND
A 55-year-old man with advanced heart failure on LVAD support was found positive for hospital-acquired COVID-19 during routine screening, then developed severe hypoxemia and died 3 days later.
This single case cannot prove how common this is.
Key findings
01The patient tested positive for SARS-CoV-2 on hospital day 21 and died 3 days later.
02On hospital day 24 he developed cough, tachypnea, and hypoxemia, then within 2 hours had oxygen saturations of 70%, hypotension, and low LVAD flows.
03Advanced cardiac life support was not performed because he was ineligible for transplant or durable LVAD and his prognosis on continued temporary support was extremely poor.
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How it was doneWhat they foundWhat it means for RNs
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What it does not show
A single case report cannot show how often hospital-acquired COVID-19 causes rapid deterioration or death in LVAD patients. The patient received many concurrent supports and therapies, including intra-aortic balloon placement, VA ECMO, Impella CP, central LVAD, renal replacement therapy, prolonged intubation, hydroxychloroquine, and anticoagulation, so the contribution of any treatment cannot be separated. The paper reports abnormal laboratory markers but does not show that they predicted the outcome in a way that can be applied to other patients. There was no control group, randomisation, or blinding, and the authors' discussion of timing of therapy and thromboembolism is speculative. The case occurred during a pandemic with hospital screening and visitor policies, so infection-control details may not generalise.
Declared interests
No conflict of interest or disclosures relevant for this publication.
The easy way to misread this
Do not read the death as proof that hydroxychloroquine caused the collapse. He was on multiple mechanical supports and had abnormal inflammatory markers, and the paper cannot separate the contribution of any treatment.