Extracorporeal Life Support Organization Coronavirus Disease 2019 Interim Guidelines: A Consensus Document from an International Group of Interdisciplinary Extracorporeal Membrane Oxygenation Providers

Abstract

Disclaimer: The Extracorporeal Life Support Organization (ELSO) Coronavirus Disease 2019 (COVID-19) Guidelines have been developed to assist existing extracorporeal membrane oxygenation (ECMO) centers to prepare and plan provision of ECMO during the ongoing pandemic. The recommendations have been put together by a team of interdisciplinary ECMO providers from around the world. Recommendations are based on available evidence, existing best practice guidelines, ethical principles, and expert opinion. This is a living document and will be regularly updated when new information becomes available. ELSO is not liable for the accuracy or completeness of the information in this document. These guidelines are not meant to replace sound clinical judgment or specialist consultation but rather to strengthen provision and clinical management of ECMO specifically, in the context of the COVID-19 pandemic.

Figure 1.

Key considerations on which these guidelines are based.

Figure 2.

ECMO provision based on system capacity. COVID-19, coronavirus disease 2019; ECMO, extracorporeal membrane oxygenation; ECPR, extracorporeal cardiopulmonary resuscitation; ICU, intensive care unit; VA, venoarterial; VV, venovenous.

Figure 3.

Conventional VV indications for ARDS. ARDS, acute respiratory distress syndrome; ECMO, extracorporeal membrane oxygenation; FiO₂, fraction of inspired oxygen; PaCO₂, partial pressure of carbon dioxide; PaO₂, partial pressure of oxygen; PEEP, positive end-expiratory pressure; VV, venovenous.

Figure 4.

Summary of patient management on ECMO. ARDS, acute respiratory distress syndrome; bpm, beats per minute; COVID-19, coronavirus disease 2019; CS, cardiogenic shock; CT, computed tomography; DVT, deep venous thrombosis; ECMO, extracorporeal membrane oxygenation; FiO₂, fraction of inspired oxygen; Hb, hemoglobin; IVC, inferior vena cava; MV, mechanical ventilation; PD, pharmacodynamics; PEEP, positive end-expiratory pressure; PK, pharmacokinetics; PLT, platelets; PPE, personal protective equipment; P_PLAT, plateau pressure; PT, physiotherapy; RCT, randomized controlled trial; RR, respiratory rate; SpO₂, peripheral saturation of oxygen; XR, x-rays.