Respiratory indications for ECMO: focus on COVID-19

Area of Science:

• Critical Care Medicine
• Respiratory Medicine
• Cardiopulmonary Support

Background:

• Extracorporeal membrane oxygenation (ECMO) use has risen for severe respiratory failure, particularly during the COVID-19 pandemic.
• Evidence supports ECMO with ultra-lung-protective ventilation for select severe ARDS patients.
• The evolving role of ECMO in COVID-19 requires ongoing evaluation.

Purpose of the Study:

• To review the current evidence on ECMO use in severe respiratory failure, focusing on COVID-19 patients.
• To identify factors influencing ECMO outcomes in the context of the pandemic.
• To discuss the judicious application and resource implications of ECMO.

Main Methods:

• Analysis of randomized controlled trials, Bayesian analysis, and meta-analyses for ARDS.
• Review of large cohort data for COVID-19 patients treated with ECMO.
• Identification and discussion of known mortality risk factors.

Main Results:

• ECMO benefits ARDS patients when combined with ultra-lung-protective ventilation.
• Initial COVID-19 ECMO outcomes were comparable to non-COVID-19 cohorts.
• Mortality in ECMO-supported COVID-19 patients increased over time, with unclear reasons.

Conclusions:

• Factors like patient age, organ failure, prolonged ventilation, team experience, and center volume impact ECMO mortality.
• ECMO is resource-intensive and requires judicious use, especially during scarcity.
• Further high-quality research is needed to define ECMO's role and limitations in severe COVID-19.