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Intensive Care Medicine
Published in: Intensive Care Medicine 10/2022

09-08-2022 | Acute Respiratory Distress-Syndrome | Review

Respiratory indications for ECMO: focus on COVID-19

Authors: Alexander Supady, Alain Combes, Ryan P. Barbaro, Luigi Camporota, Rodrigo Diaz, Eddy Fan, Marco Giani, Carol Hodgson, Catherine L. Hough, Christian Karagiannidis, Matthias Kochanek, Ahmed A. Rabie, Jordi Riera, Arthur S. Slutsky, Daniel Brodie

Published in: Intensive Care Medicine | Issue 10/2022

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Abstract

Extracorporeal membrane oxygenation (ECMO) is increasingly being used for patients with severe respiratory failure and has received particular attention during the coronavirus disease 2019 (COVID-19) pandemic. Evidence from two key randomized controlled trials, a subsequent post hoc Bayesian analysis, and meta-analyses support the interpretation of a benefit of ECMO in combination with ultra-lung-protective ventilation for select patients with very severe forms of acute respiratory distress syndrome (ARDS). During the pandemic, new evidence has emerged helping to better define the role of ECMO for patients with COVID-19. Results from large cohorts suggest outcomes during the first wave of the pandemic were similar to those in non-COVID-19 cohorts. As the pandemic continued, mortality of patients supported with ECMO has increased. However, the precise reasons for this observation are unclear. Known risk factors for mortality in COVID-19 and non-COVID-19 patients are higher patient age, concomitant extra-pulmonary organ failures or malignancies, prolonged mechanical ventilation before ECMO, less experienced treatment teams and lower ECMO caseloads in the treating center. ECMO is a high resource-dependent support option; therefore, it should be used judiciously, and its availability may need to be constrained when resources are scarce. More evidence from high-quality research is required to better define the role and limitations of ECMO in patients with severe COVID-19.
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Metadata
Title
Respiratory indications for ECMO: focus on COVID-19
Authors
Alexander Supady
Alain Combes
Ryan P. Barbaro
Luigi Camporota
Rodrigo Diaz
Eddy Fan
Marco Giani
Carol Hodgson
Catherine L. Hough
Christian Karagiannidis
Matthias Kochanek
Ahmed A. Rabie
Jordi Riera
Arthur S. Slutsky
Daniel Brodie
Publication date
09-08-2022
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 10/2022
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-022-06815-w

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