Ventricular septal rupture and cardiogenic shock complicating STEMI during COVID-19 pandemic: An old foe re-emerges.
Hooman Bakhshi, Raghav Gattani, Emmanuel Ekanem and 7 others
PMID 33387761WHAT IT FOUND
Two men with late-presenting STEMI and ventricular septal rupture survived to heart transplant after VA-ECMO bridging.
One had toe amputation from ECMO-related clotting. This describes their course, not proof that ECMO caused survival.
Key findings
01Each patient was placed on VA-ECMO with atrial septal drainage for LV venting as a bridge to cardiac replacement or definitive therapy.
02Each patient underwent heart transplantation.
03A patient developed bilateral toe amputation after transplant because of distal thromboembolization, a complication of ECMO.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a report of two patients, so it cannot show that VA-ECMO, LV venting, or heart transplantation caused survival. No control group or comparison treatment was studied. The patients received many treatments together, including stents, vasopressors, IABP, mechanical ventilation, VA-ECMO, LV venting, and transplantation, so the contribution of any one component cannot be separated. Both were managed at a tertiary center with access to transplant, so the course may not apply to hospitals without these services. The report describes selected severe cases, not all patients with ventricular septal rupture after STEMI.
Declared interests
Ramesh Singh reported Baxter speaker fees. Behnam Tehrani reported Medtronic consulting and speaker fees. Wayne Batchelor reported Abbott consulting and speaker fees, Boston Scientific consulting, and vWave consulting. Hooman Bakhshi, Raghav Gattani, Emmanuel Ekanem, Mehul Desai, Alan M Speir, Shashank Sinha, and Matthew W Sherwood declared no disclosures.
The easy way to misread this
Do not conclude that VA-ECMO with LV venting caused survival or should be used routinely for ventricular septal rupture. This report has no comparison group, and the patients received many treatments at once, including stents, vasopressors, IABP, mechanical ventilation, VA-ECMO, LV venting, and transplantation, so the contribution of any one component cannot be separated.