COVID-19 and Extracorporeal Membrane Oxygenation

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Cardiopulmonary Support

Background:

• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic necessitates advanced respiratory support strategies.
• Refractory respiratory failure in COVID-19 patients may benefit from veno-venous extracorporeal membrane oxygenation (V-V ECMO).

Purpose of the Study:

• To review the current evidence on the use of V-V ECMO for treating COVID-19 patients.
• To assess the efficacy and outcomes of ECMO in the context of the SARS-CoV-2 pandemic.

Main Methods:

• A comprehensive literature search of electronic databases was conducted up to June 12, 2020.
• Keywords included SARS-CoV-2, COVID-19, ECMO, and extracorporeal life support (ECLS).
• Two independent investigators screened the reports.

Main Results:

• Thirty-two studies involving 4,912 COVID-19 patients were analyzed.
• 21% of patients (1,015) were treated with ECMO, with a mortality rate of up to 34.6% in this subgroup.
• COVID-19-associated "cytokine storm" and hematological changes can complicate ECMO therapy.

Conclusions:

• ECMO efficacy for COVID-19 is contingent upon center expertise in extracorporeal life support (ECLS).
• V-V ECMO is a viable option for critically ill COVID-19 patients requiring gas exchange support.
• Given resource constraints during the pandemic, ECMO should be prioritized for the most severe cases.