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

Excerpt

The coronavirus disease 2019 (COVID-19) pandemic has led to a critical shortage of resources in the hardest-hit areas around the world [1]. Intensive care units (ICUs) overwhelmed by critically ill patients may create non-conventional ICU spaces and even consider triaging invasive mechanical ventilation to those most likely to benefit [2]. 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]. An important question then is whether a resource-intensive therapy is warranted when systems are already strained [5]. …