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An Interview With an Italian Intensivist on the COVID Experience in Italy – American College of Cardiology

Key Points:

 

 

  • Reaffirms primary presentation is respiratory
  • Cardiovascular Involvement is definite; often myocarditis, but concerns of excluding traditional infarction induced by high inflammatory markers.
  • Use of Hemodynamic support is used selectively, often with V-V ECMO for oxygenation but other considerations include conversion to V-A ECMO with considerations for Impella unloading (ECPella)
  • Challenges in managing cardiogenic shock include limitation of Right Heart Catheterization and the challenges of potentially placing an Impella in the ICU. (See Posted article on A-Cure sight Pappalardo description of ICU Impella Insertion.)
  • Deciding on Resource utilization generally targets patients based on blood pressure levels, pressors required and Left Ventricular Ejection Fraction.