Extracorporeal Membrane Oxygenation Circuits in Parallel for Refractory Hypoxemia in COVID-19: A Case Series

Refractory hypoxemia despite the use of extracorporeal membrane oxygenation (ECMO) for coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome remains a challenging problem. A single ECMO circuit may not provide adequate physiologic support in the setting of an elevated cardiac output, physiologic demand, and impaired gas exchange. In select patients with refractory hypoxemia, addition of a second ECMO circuit in parallel can improve oxygenation, facilitate lung protective ventilation, awakening, and physical rehabilitation. We report the largest case series to date of patients receiving ECMO circuits in parallel and the first to report this approach in COVID-19.