Veno-venous extracorporeal membrane oxygenation (ECMO) support surged during the COVID-19 pandemic. Our program changed the model of care pursuing to protect the multidisciplinary team from the risk of infection and to serve as many patients as possible. Patient–healthcare interactions were restricted, and the ECMO bed capacity was increased by reducing the ECMO specialist–patient ratio to 1:4 with non-ECMO trained nurses support. The outcomes worsened and we paused while we evaluated and modified our model of care. The ECMO bed capacity was reduced to allow a nurse ECMO–specialist nurse ratio 2:1 with an ECMO trained nurse assistant’s support. Intensivists, general practitioners, nurse assistants, and physical and respiratory therapists were trained on ECMO. Tracheostomy, bronchoscopy, and microbiological molecular diagnosis were done earlier, and family visits and rehabilitation were allowed in the first 48 hours of ECMO cannulation. There were 35 patients in the preintervention cohort and 66 in the postintervention cohort. Ninety days mortality was significantly lower after the intervention (62.9% vs. 31.8%, p = 0.003). Factors associated with increased risk of death were the need for cannulation or conversion to veno arterial or veno arterio venous ECMO, hemorrhagic stroke, and renal replacement therapy during ECMO. The interventions associated with a decrease in the risk of death were the following: early fiberoptic bronchoscopy and microbiological molecular diagnostic tests. Increasing the ECMO multidisciplinary team in relation to the number of patients and the earlier performance of diagnostic and therapeutic interventions, such as tracheostomy, fiberoptic bronchoscopy, molecular microbiological diagnosis of pneumonia, rehabilitation, and family support significantly decreased mortality of patients on ECMO due to COVID-19.

El infarto de miocardio sin lesiones en arterias coronarias obstructivas y la angina sin  lesiones obstructivas, son entidades clínicas desconcertantes que se caracterizan por evidencia clínica de angina o infarto de miocardio con arterias coronarias normales o casi normales en la angiografía (estenosis <50%). Se realizo una revision bibliografica sobre la etiologia, clasificacion y mecanismos responsables de estas entidades. Los metodos de selección de los articulos se basaron en la literatura medica generada al respecto desde el año 2000 hasta el año 2022 a traves de pubmed, se incluyeron todos los metanalisis, estudios aleatorizados controlados, revisiones, estudios experimentales en pacientes mayores de 18 años, excluyendose aquellos que no cumplieran con los criterios de seleccion. La patogenia precisa no se comprende bien y se está estudiando y examinando más a fondo. Las guías indican que MINOCA o ANOCA son un grupo de enfermedades heterogéneas con diferentes mecanismos fisiopatologicos. Dado que existen múltiples mecanismos implicados, no es seguro que la prevención secundaria clásica y la estrategia de tratamiento para la enfermedad arterial coronaria obstructiva sea óptima para estos pacientes. La utilizacion de la tomografia de coherencia optica, la resonancia magnetica cardiaca y el ultrasonido intravascular se han planteado como estudios de estratificacion Siguen siendo muchas las dudas sobre la fisiopatologia, pronostico, estudios a posteriori tras el cateterismo cardiacos asi como conductas terapeuticas optimas. Dentro del manejo terapeutico se han descrito los farmacos anti agregantes, betabloqueantes, calcio antagonistas y los hipolipemiantes. Seran los proximos estudios con grandes cohortes de pacientes las que permitan responder adecuadamente al disponerse de evidencia cientifica de alta relevancia al respecto.