Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases

• Type of Material: Article
• Authors: Kollengode Ramanathan, National University Singapore; David Antognini, University of Queensland; Alain Combes, University of Paris; Matthew Paden, Emory University; Bishoy Zakhary, Oregon Health and Science University; Mark Ogino, Thomas Jefferson University; Graeme MacLaren, National University Singapore; Daniel Brodie, Columbia University; Kiran Shekar, Bond University
• Language: English
• Date: 2020-05-01
• Publisher: Elsevier Science Ltd.
• Publication Version: Final Published Version
• Copyright Statement: © 2020 Elsevier Ltd.
• Final Published Version (URL): http://dx.doi.org/10.1016/S2213-2600(20)30121-1
• Title of Journal or Parent Work: The Lancet: Respiratory Medicine
• Volume: 8
• Issue: 5
• Start Page: 518
• End Page: 526
• Grant/Funding Information: KS thanks Metro North Hospital and Health Service (Brisbane, QLD, Australia) for research fellowship support.
• Keywords: General & Internal Medicine; Influenza; Respiratory System; Mechanical ventilation; Intensive Care Units; Organization; Extracorporeal membrana oxygenation; Critical Care Medicine; Ethical dilemmas; Science & Technology; Position papers; Life-support; Life Sciences & Biomedicine; Clinical characteristics; Respiratory failure
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology; Health Sciences, Health Care Management

Abstract

WHO interim guidelines recommend offering extracorporeal membrane oxygenation (ECMO) to eligible patients with acute respiratory distress syndrome (ARDS) related to coronavirus disease 2019 (COVID-19). The number of patients with COVID-19 infection who might develop severe ARDS that is refractory to maximal medical management and require this level of support is currently unknown. Available evidence from similar patient populations suggests that carefully selected patients with severe ARDS who do not benefit from conventional treatment might be successfully supported with venovenous ECMO. The need for ECMO is relatively low and its use is mostly restricted to specialised centres globally. Providing complex therapies such as ECMO during outbreaks of emerging infectious diseases has unique challenges. Careful planning, judicious resource allocation, and training of personnel to provide complex therapeutic interventions while adhering to strict infection control measures are all crucial components of an ECMO action plan. ECMO can be initiated in specialist centres, or patients can receive ECMO during transportation from a centre that is not specialised for this procedure to an expert ECMO centre. Ensuring that systems enable safe and coordinated movement of critically ill patients, staff, and equipment is important to improve ECMO access. ECMO preparedness for the COVID-19 pandemic is important in view of the high transmission rate of the virus and respiratory-related mortality.