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Extracorporeal Membrane Oxygenation Selection by Multidisciplinary Consensus: The ECMO Council

Whitney D Gannon1, Anil J Trindade1, John W Stokes2

  • 1From the Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|May 11, 2022
PubMed

Insights

A multidisciplinary ECMO Council and standardized framework proved feasible for selecting patients with acute respiratory failure during the COVID-19 pandemic, despite resource limitations. This approach facilitated consistent decision-making for extracorporeal membrane oxygenation (ECMO) consults.

Area of Science:

  • Critical Care Medicine
  • Cardiopulmonary Support
  • Infectious Diseases

Background:

  • The COVID-19 pandemic significantly increased demand for extracorporeal membrane oxygenation (ECMO).
  • Patient selection for ECMO faced challenges due to resource limitations and a lack of standardized processes.
  • Data on ECMO consults were historically underreported, highlighting a need for structured evaluation.

Purpose of the Study:

  • To evaluate the implementation of a multidisciplinary selection committee (ECMO Council).
  • To assess a standardized framework for patient selection for ECMO during a pandemic.
  • To analyze ECMO consult data and decision-making processes at a single academic medical center.

Main Methods:

  • Retrospective review of consecutive adult ECMO consults for acute respiratory failure (April 2020 - February 2021).
  • Implementation and utilization of a multidisciplinary ECMO Council via electronic teleconference.
  • Analysis of reasons for ECMO initiation or decline, including contraindications and resource limitations.

Main Results:

  • 202 ECMO consults were reviewed; 86.1% involved COVID-19 patients.
  • 77.7% of consults were declined, with common reasons including contraindications and resource limits.
  • 41 consults (20.3%) resulted in ECMO initiation; the ECMO Council deliberated on 96 cases without absolute contraindications.

Conclusions:

  • A multidisciplinary consensus and standardized process for ECMO patient selection are feasible during a pandemic.
  • This structured approach can be reliably exercised over time for managing ECMO consults.
  • The generalizability of this ECMO selection framework to other institutions remains to be determined.

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