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Selection criteria and triage in extracorporeal membrane oxygenation during coronavirus disease 2019

Pasquale Nardelli1,2, Anna Mara Scandroglio1, Maria Elena De Piero2

  • 1Department of Cardiac Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.

Current Opinion in Critical Care
|October 27, 2022
PubMed

Insights

The COVID-19 pandemic necessitated adaptive hospital resource management, particularly for extracorporeal membrane oxygenation (ECMO). Flexible ECMO guidelines and frequent reassessment of healthcare capacity are crucial for effective patient triage during critical events.

Area of Science:

  • Critical Care Medicine
  • Public Health Policy

Background:

  • The COVID-19 pandemic significantly impacted hospital and intensive care unit (ICU) resource management.
  • Advanced life support techniques, such as extracorporeal membrane oxygenation (ECMO), faced unprecedented demand.

Approach:

  • Implementing contingency capacity tiers for ECMO allocation during pandemics.
  • Integrating regional healthcare coordination systems for resource saturation monitoring.
  • Establishing a hub-and-spoke healthcare system for wider resource distribution.

Key Points:

  • Global availability of ICU beds and ECMO machines varies significantly.
  • Patient candidacy for ECMO requires consideration of acute disease, comorbidities, and quality of life post-recovery.
  • Healthcare system capacity must be frequently reassessed and factored into ECMO indications.

Conclusions:

  • Pandemic-era ECMO indications should be fluid and adaptable.
  • Dynamic patient triage, considering both clinical need and system capacity, is essential.
  • A flexible, coordinated approach to critical care resource management is vital for optimizing patient outcomes.
Abstract

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