Extracorporeal membrane oxygenation support for tropical infections: a scoping review

Extracorporeal membrane oxygenation (ECMO) for infectious causes of refractory cardiopulmonary failure is established as appropriate therapy in high-income countries. Its use in low- and middle-income nations for tropical infections is not well-studied, however, perhaps because most of these countries have not been historically able to offer ECMO support. Tropical infections remain an important cause of global morbidity and mortality, but the role of ECMO is poorly described.

We identified a list of viral, bacterial, fungal, and parasitic infections that qualified as tropical infectious diseases. These included infections that were either a World Health Organization (WHO) designated Neglected Tropical Disease (NTD) or an infectious disease with a higher prevalence in the Tropics than elsewhere. We conducted a comprehensive review of existing literature regarding ECMO use to support these infections.

Multiple viral, bacterial, fungal, and parasitic tropical infections have been supported by ECMO with varying success. leptospirosis, melioidosis, and tuberculosis are conditions suitable for venovenous ECMO support with frequent use in the literature and reported survival as high as 84% in Leptospirosis. Venoarterial ECMO has been successfully used in American trypanosomiasis-related cardiogenic shock as a bridge to transplant, with one center reporting a 71% survival rate. Dengue and malaria have been successfully supported with both venovenous and venoarterial ECMO. Mortality is relatively high (> 65%) in patients who receive ECMO for Middle Eastern Respiratory Syndrome. ECMO has also supported Echinococcal infections perioperatively. There are multiple tropical infections where ECMO use has not been published.

As the use of ECMO expands globally, more patients with tropical infections may require ECMO in both endemic and non-endemic settings. We present a scoping review on the evidence base of ECMO use to support tropical infectious diseases, with data regarding feasibility in specific disease processes as well as clinical considerations for tropical diseases on the ECMO circuit.