Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases

Abstract

WHO interim guidelines recommend offering extracorporeal membrane oxygenation (ECMO) to eligible patients with acute respiratory distress syndrome (ARDS) related to coronavirus disease 2019 (COVID-19). The number of patients with COVID-19 infection who might develop severe ARDS that is refractory to maximal medical management and require this level of support is currently unknown. Available evidence from similar patient populations suggests that carefully selected patients with severe ARDS who do not benefit from conventional treatment might be successfully supported with venovenous ECMO. The need for ECMO is relatively low and its use is mostly restricted to specialised centres globally. Providing complex therapies such as ECMO during outbreaks of emerging infectious diseases has unique challenges. Careful planning, judicious resource allocation, and training of personnel to provide complex therapeutic interventions while adhering to strict infection control measures are all crucial components of an ECMO action plan. ECMO can be initiated in specialist centres, or patients can receive ECMO during transportation from a centre that is not specialised for this procedure to an expert ECMO centre. Ensuring that systems enable safe and coordinated movement of critically ill patients, staff, and equipment is important to improve ECMO access. ECMO preparedness for the COVID-19 pandemic is important in view of the high transmission rate of the virus and respiratory-related mortality.

Figure 1

Global ECMO capacity according to ELSO (A) Number of ECMO centres registered with ELSO and number of ECMO runs per year. (B) Geographical distribution of ELSO-registered ECMO centres as of January, 2020. Adapted from the ECMO registry of ELSO, by permission of ELSO. ECMO=extracorporeal membrane oxygenation. ELSO=Extracorporeal Life Support Organization.

Figure 2

Key elements for planning of ECMO services Developing organisations that support systems, equipment, facilities, and personnel is crucial to ensure optimal patient care, as well as family and staff safety during outbreaks of emerging infectious diseases. PAPR=power air-purifying respirator. PPE=personal protective equipment.