key: cord-0865092-u4ppxutk
authors: Pagani, Francis D.
title: Commentary: The Evolution of Extracorporeal Membrane Oxygenation (ECMO) for COVID-19: Through the Eyes of the Experts
date: 2021-10-28
journal: J Thorac Cardiovasc Surg
DOI: 10.1016/j.jtcvs.2021.10.036
sha: b5ee4d0d1db1f73ea49d56828542888c307424dc
doc_id: 865092
cord_uid: u4ppxutk

nan

Similar to past experiences with global outbreaks of viral syndromes that have caused significant respiratory disease, extracorporeal membrane oxygenation (ECMO) has emerged as a viable treatment for respiratory failure not responding to optimal or conventional standards and has again emerged as a successful rescue strategy. At the start of the pandemic, the use of ECMO as a rescue strategy and its outcomes remained uncertain but experience evolved quickly and ECMO has been adopted in more cases of respiratory failure from COVID-19 disease. In an expert review presented in the Journal,(1) Dr. Hayanga and colleagues provide a succinct overview of the important observations noted and practices adopted during the evolution of the pandemic that have provided greater insight into the selection and management of patients receiving ECMO for J o u r n a l P r e -p r o o f COVID-19 respiratory failure. These important incites include observations on how patient characteristics for those receiving ECMO have evolved during the pandemic, a diagram outlining a triage protocol for centers without ECMO to refer to an ECMO center, a table listing important information deficits that require further investigation, pharmacological adjuncts, and ECMO procedural considerations for lung management, cannulation and equipment necessary for ECMO support. Importantly, resource management during a pandemic, including availability of ECMO circuits becomes a critical issue, which the authors have addressed by providing insight from experiences coordinating regional ECMO resources. Co-morbid conditions, particularly obesity have been a contributing factor to the incidence of respiratory failure with COVID-19 disease.

The authors specifically provide consensus practices for these paitents.

As the authors point out, the evolution of the use of ECMO during the pandemic has largely occurred through the reports of non-randomized, single center experiences and observations. The lack of data obtained from rigorous, prospective multi-center trials and lack of consensus opinion has resulted in significant management variation and knowledge gaps and has been an important limitation in refining ECMO practices for COVID-19 respiratory failure. This important work by a group of recognized experts in the field of ECMO has provided an informative report on a collective experience and provides consensus opinion for the readers.

Venovenous extracorporeal membrane oxygenation in patients with COVID-19 respiratory failure