Treating COVID-19 Patients With Acute Heart Failure
A paper published in two medical journals last week offers guidelines for physicians treating coronavirus patients requiring advanced life-saving therapies.
Dr. Marvin Slepian, University of Arizona Regents Professor of Medicine, and Dr. Christian Bime, an assistant professor in the College of Medicine – Tucson, are among the co-authors of a research paper that offers guidelines for treating COVID-19 patients who develop acute heart failure.
The paper, "Advanced Pulmonary and Cardiac Support of COVID-19 Patients: Emerging Recommendations from ASAIO – A Living Working Document," is published in the ASAIO Journal, the journal of the American Society for Artificial Internal Organs, a professional organization whose members include physicians, engineers, scientists and industry professionals. It also appears in the journal Circulation: Heart Failure.
The paper is a work in progress and will be continually updated as new information is evaluated with regard to novel coronavirus and care for critically ill patients, said Slepian, president of ASAIO and the first person ever be elected to serve a second term in that role.
"A large number of patients hospitalized for COVID-19 develop severe respiratory compromise. While many are treated successfully with ventilators, a significant number deteriorate, needing enhanced methods of oxygenation. Beyond lung deterioration, a subgroup of these failing patients develops heart dysfunction with acute heart failure," said Slepian, a professor in the UArizona College of Medicine – Tucson and College of Engineering and a member of the university's Sarver Heart Center and BIO5 Institute.
"For these patients, an advanced treatment method known as ECMO – extracorporeal membrane oxygenation, is the best life-saving technology we have today. Here, rapid placement of mechanical circulatory support systems – support and augmentation pumps, with ECMO – is needed to essentially replace heart and lung function," said Slepian, who also is founding director of the Arizona Center for Accelerated Biomedical Innovation, a university "creativity engine" or "inventors' workshop" that helps faculty members and students develop ideas into products that improve life and health.
Extracorporeal membrane oxygenation and mechanical circulatory support systems are advanced therapeutic techniques practiced largely at U.S. tertiary and referral medical centers by specialists in cardiac, cardiovascular surgical, pulmonary and related fields. But health care workers who don't perform these methods on a routine basis often don't know their intricacies and best practices.
ASAIO, a society of physicians, engineers, scientists and industry, has been at the forefront of developing both methods and the systems, clinical knowledge and skills needed to move the technologies safely and effectively into broader clinical use.
A cardiologist by training, Slepian, who also is a past president of the International Society for Mechanical Circulatory Support, assembled a group of leading cardiac, cardiovascular surgical and pulmonary specialists from around the world to put together a recommended best practices to facilitate rapid widespread use of this life-saving technology in response to COVID-19. The paper appears on the ASAIO Action portal, which allows physicians to share their experiences, comments and suggestions. Top advances will be added to the portal as they occur, allowing cardiac and pulmonary specialists to refine advanced lifesaving techniques through worldwide collaboration.
Bime, the other UArizona co-author on the paper, is an assistant professor in the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at the College of Medicine – Tucson and director of the medical intensive care unit at Banner – University Medical Center Tucson.
Dr. Nancy Sweitzer, who is the Sarver Heart Center director, chief of the Division of Cardiology and a professor of medicine at the College of Medicine – Tucson, is the editor-in-chief of Circulation: Heart Failure, a publication of the American Heart Association.
"This paper is meant to be a living document to advance best practices for widespread dissemination," Slepian said. "The strategy of the living document is that while U.S. experts are providing their best-practice recommendations, their actual experience with COVID-19 will evolve with additional frontline cases around the globe. As new insights, new adaptations and improvements emerge, these advances will rapidly be published and put online subsequently as supplement or updates to the present paper."
A version of this story originally appeared on the University of Arizona Health Sciences website: https://uahs.arizona.edu/news/two-uarizona-physicians-among-authors-asaio-paper-cardiopulmonary-life-support-advanced-covid.
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