key: cord-0852238-fliudtls
authors: Singh, Gurmeet; Brodie, Daniel
title: Commentary: Protecting the Right Ventricle in COVID-19 ARDS - More Data Required
date: 2020-07-16
journal: J Thorac Cardiovasc Surg
DOI: 10.1016/j.jtcvs.2020.07.043
sha: a9d831414dd676073ab3ee5dd10c6ebd52b03c0f
doc_id: 852238
cord_uid: fliudtls

nan

Oxy-RVAD has been proposed for COVID-19-associated ARDS as superior to mechanical 2 ventilation and, by implication, ECMO, because it provides RV support. More data are required 3 before adoption. If the oxy-RVAD approach is rational and feasible, is it advisable? One issue raised by Dr. 33 Joyce is cost. Clearly, any future study of an oxy-RVAD in this setting, as with ECMO, should 34 be accompanied by detailed cost-benefit analyses. So, while this too may be feasible, it must be seen as an additional experiment. As Dr. Joyce says: "Anecdotal evidence should always be viewed with a degree of skepticism." 45 We agree. The experience described is intriguing, but preliminary, with insufficient data to 46 guide clinical practice or broader recommendations. As we learn more about COVID-19-47 associated RV failure, the specific need in this context may become clearer. Notwithstanding the 48 separate issue of extubating patients during ECMO (or oxy-RVAD) support, the broader 49 hypothesis may be applicable to any severe ARDS patient with concomitant severe RV 50 4 dysfunction. Clearly, more data are needed, and we look forward to Dr. Joyce's planned 51 multicenter randomized clinical trial.

Experts' opinion on management of 54 hemodynamics in ARDS patients: focus on the effects of mechanical ventilation

Acute Respiratory Distress Syndrome

Extracorporeal Membrane Oxygenation for 60

Severe Acute Respiratory Distress Syndrome and Posterior Probability of Mortality Benefit 61 in a Post Hoc Bayesian Analysis of a Randomized Clinical Trial

Right Ventricular Unloading after Initiation 64 of Venovenous Extracorporeal Membrane Oxygenation

Mechanical Ventilation: A Necessary Evil?

Mechanical Ventilation to Minimize Progression of Lung 69

Injury in Acute Respiratory Failure