Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jun 15;205(12):1382-1390.
doi: 10.1164/rccm.202111-2661CP.

Extracorporeal Membrane Oxygenation during Respiratory Pandemics: Past, Present, and Future

Daniel Brodie  1   2 , Darryl Abrams  1   2 , Graeme MacLaren  3 , Crystal E Brown  4 , Laura Evans  5 , Ryan P Barbaro  6 , Carolyn S Calfee  7 , Catherine L Hough  8 , Jo-Anne Fowles  9 , Christian Karagiannidis  10 , Arthur S Slutsky  11   12   13 , Alain Combes  14   15
Affiliations
Review

Extracorporeal Membrane Oxygenation during Respiratory Pandemics: Past, Present, and Future

Daniel Brodie et al. Am J Respir Crit Care Med. .

Abstract

The role of extracorporeal membrane oxygenation (ECMO) in the management of severe acute respiratory failure, including acute respiratory distress syndrome, has become better defined in recent years in light of emerging high-quality evidence and technological advances. Use of ECMO has consequently increased throughout many parts of the world. The coronavirus disease (COVID-19) pandemic, however, has highlighted deficiencies in organizational capacity, research capability, knowledge sharing, and resource use. Although governments, medical societies, hospital systems, and clinicians were collectively unprepared for the scope of this pandemic, the use of ECMO, a highly resource-intensive and specialized form of life support, presented specific logistical and ethical challenges. As the pandemic has evolved, there has been greater collaboration in the use of ECMO across centers and regions, together with more robust data reporting through international registries and observational studies. Nevertheless, centralization of ECMO capacity is lacking in many regions of the world, and equitable use of ECMO resources remains uneven. There are no widely available mechanisms to conduct large-scale, rigorous clinical trials in real time. In this critical care review, we outline lessons learned during COVID-19 and prior respiratory pandemics in which ECMO was used, and we describe how we might apply these lessons going forward, both during the ongoing COVID-19 pandemic and in the future.

Keywords: COVID-19; ECMO; acute respiratory distress syndrome; extracorporeal circulation; respiratory failure.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Specific considerations for extracorporeal membrane oxygenation (ECMO) for coronavirus disease (COVID-19) that may differ from ECMO for non–COVID-19 indications. RV = right ventricular.
Figure 2.
Figure 2.
Preparing for extracorporeal membrane oxygenation (ECMO) during the next respiratory pandemic.
Figure 3.
Figure 3.
(A and B) Extracorporeal membrane oxygenation (ECMO)-related challenges and uncertainties encountered during the coronavirus disease (COVID-19) pandemic (A) and opportunities afforded by the pandemic (B). RCT = randomized controlled trial; VILI = ventilator-induced lung injury; VPA = venous drainage combined with pulmonary arterial reinfusion.
See this image and copyright information in PMC

References

    1. Pham T, Combes A, Rozé H, Chevret S, Mercat A, Roch A, et al. REVA Research Network Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis. Am J Respir Crit Care Med . 2013;187:276–285. - PubMed
    1. Noah MA, Peek GJ, Finney SJ, Griffiths MJ, Harrison DA, Grieve R, et al. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1) JAMA . 2011;306:1659–1668. - PubMed
    1. Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, et al. CESAR trial collaboration Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet . 2009;374:1351–1363. - PubMed
    1. Brodie D, Slutsky AS, Combes A. Extracorporeal life support for adults with respiratory failure and related indications: a review. JAMA . 2019;322:557–568. - PubMed
    1. Choi WS, Kang CI, Kim Y, Choi JP, Joh JS, Shin HS, et al. Korean Society of Infectious Diseases Clinical presentation and outcomes of Middle East respiratory syndrome in the Republic of Korea. Infect Chemother . 2016;48:118–126. - PMC - PubMed