The role of ECMO in COVID‐19: Can it provide rescue therapy in those who are critically ill?

Abstract

Arising from the city of Wuhan, Hubei province in China, a novel coronavirus named severe acute respiratory syndrome coronavirus 2 has been rapidly spreading since its first presentation in late 2019. The World Health Organization declared a pandemic on the 11th March 2020, and as of 29th of April 2020 more than 3 million cases have been reported worldwide with over 225 000 confirmed deaths. Where mechanical ventilation may not be enough, extracorporeal membrane oxygenation (ECMO) could play a role as a form of rescue therapy and may provide beneficial results in the hands of skilled clinicians in centers with experience of using ECMO appropriately in selected patients. Our understanding of COVID‐19 is ever‐changing and the need for intensive care beds is rising, which means that ECMO will surely play a key role in the near future.

Role of extracorporeal membrane oxygenation in COVID‐19: A systematic review

“…More research should also be conducted on the effectiveness of blood filters such as Cytosorb, which can be used during ECMO treatments to remove cytokines and ease the stress on the cardiovascular and respiratory systems, thereby helping mitigate cytokine‐storm‐related complications. Although there have been several studies proving its benefits and it has been approved by the FDA, more clinical trials are needed for a conclusive answer regarding its use in COVID‐19 48‐50 …”

ECMO during the COVID-19 pandemic: when is it unjustified?

“…In the most severe cases of refractory hypoxemia, extracorporeal membrane oxygenation (ECMO) may be considered, as recommended by the World Health Organization for severe COVID-19. Early data suggest there may be a benefit from ECMO in certain patients with COVID-19-associated respiratory failure, though outcomes are likely to be highly dependent on patient selection and timing of ECMO initiation [3]. Whether certain phenotypes of COVID-19 (if present) have differential responses to and prognoses with ECMO remains to be determined [4].…”

Successful mobile extracorporeal membrane oxygenator for COVID‐19 severe respiratory failure

“…Health systems around the globe are overwhelmed by an unprecedented number of patients with advanced respiratory failure. The role of ECMO for selective patients with advanced respiratory failure related to COVID‐19 has been recognized, but it is a highly specialized and resource‐intensive therapy 6 . International societies recommend the provision of ECMO support by specialized centers 7 …”