Extracorporeal Membrane Oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization

• Type of Material: Article
• Authors: Jenelle Badulak, University of Washington; M. Velia Antonini, University Hospital of Parma; Christine M. Stead, Extracorporeal Life Support Organization; Lara Shekerdemian, Texas Childrens Hospital; Lakshmi Raman, University of Texas Southwestern Medical Center; Matthew Paden, Emory University; Cara Agerstrand, Columbia University College of Physicians and Surgeons; Robert H. Bartlett, University of Michigan; Nicholas Barrett, Guys & St Thomas NHS Foundation Trust; Alain Combes, Sorbonne Universite; Roberto Lorusso, Maastricht University; Thomas Mueller, University Hospital Regensburg; Mark T. Ogino, Nemours Childrens Healthcare System; Giles Peek, University of Florida; Vincent Pellegrino, Alfred Health Melbourne; Ahmed A. Rabie, Ministry of Health Saudi Arabia; Leonardo Salazar, Fundacion Cardiovascular de Colombia; Matthieu Schmidt, Sorbonne Universite; Kiran Shekar, Prince Charles Hospital; Graeme MacLaren, National University of Singapore; Daniel Brodie, Columbia University College of Physicians and Surgeons
• Language: English
• Date: 2021-05-01
• Publisher: Lippincott Williams & Wilkins
• Publication Version: Final Published Version
• Copyright Statement: © ELSO 2021.
• Final Published Version (URL): http://dx.doi.org/10.1097/MAT.0000000000001422
• Title of Journal or Parent Work: ASAIO Journal
• Volume: 67
• Issue: 5
• Start Page: 485
• End Page: 495
• Grant/Funding Information: None declared
• Keywords: extracorporeal life support organization; extracorporeal membrane oxygenation; Provision; coronavirus disease 2019; Science & Technology; ECMO; extracorporeal life support program; Respiratory failure; pandemic; Transplantation; Engineering, Biomedical; Mortality; ALLOCATION; Life Sciences & Biomedicine; multisystem inflammatory syndrome in children; Predicting survival; Engineering; acute respiratory distress syndrome; Association; Programs; Document; Technology; Children
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Disclaimer: This is an updated guideline from the Extracorporeal Life Support Organization (ELSO) for the role of extracorporeal membrane oxygenation (ECMO) for patients with severe cardiopulmonary failure due to coronavirus disease 2019 (COVID-19). The great majority of COVID-19 patients (>90%) requiring ECMO have been supported using venovenous (V-V) ECMO for acute respiratory distress syndrome (ARDS). While COVID-19 ECMO run duration may be longer than in non-COVID-19 ECMO patients, published mortality appears to be similar between the two groups. However, data collection is ongoing, and there is a signal that overall mortality may be increasing. Conventional selection criteria for COVID-19-related ECMO should be used; however, when resources become more constrained during a pandemic, more stringent contraindications should be implemented. Formation of regional ECMO referral networks may facilitate communication, resource sharing, expedited patient referral, and mobile ECMO retrieval. There are no data to suggest deviation from conventional ECMO device or patient management when applying ECMO for COVID-19 patients. Rarely, children may require ECMO support for COVID-19-related ARDS, myocarditis, or multisystem inflammatory syndrome in children (MIS-C); conventional selection criteria and management practices should be the standard. We strongly encourage participation in data submission to investigate the optimal use of ECMO for COVID-19.