key: cord-0962687-vptzzflq
authors: Brozzi, Nicolas; Hernandez‐Montfort, Jaime; Noguera, Edward; McWilliams, Carla; Sheffield, Cedric; Minear, Steven; Jacobs, Jeffrey; Navas, Viviana; Velez, Mauricio; Cubeddu, Robert; Navia, Jose L.
title: Successful mobile extracorporeal membrane oxygenator for COVID‐19 severe respiratory failure
date: 2020-10-10
journal: J Card Surg
DOI: 10.1111/jocs.15106
sha: 8e9ed1d1da9a45921b0bd4471cc8272c515ef9d6
doc_id: 962687
cord_uid: vptzzflq

High volume extracorporeal membrane oxygenation (ECMO) centers have developed mobile ECMO programs in recent years to facilitate the implementation of ECMO support at hospitals with lower capabilities, and transfer these patients for further care. We report a case of mobile ECMO on a patient with coronavirus disease 2019‐related acute respiratory distress syndrome, and discuss the potential application in the current severe acute respiratory syndrome coronavirus 2 pandemic.

The public health emergency of coronavirus disease 2019 caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to compromise global health and well-being. 1 Most patients will develop mild flu-like symptoms and quickly recover, but a small subgroup of patients will progress to severe acute respiratory failure, requiring admission to an intensive care unit for an increased level of support including mechanical ventilation and extracorporeal membrane oxygenation (ECMO). 2 Recommendations for ECMO support for patients with severe pulmonary failure related to SARS-CoV-2 infection is based on current developing experiences and reports from previous epidemics. 3, 4 The World Health Organization (WHO) interim guidelines recommend the use of ECMO to support eligible patients with COVID-19 related acute respiratory distress syndrome in expert centers with sufficient volumes to ensure clinical expertise. The Food and Drug Administration has recently approved the application of ECMO and cardiopulmonary bypass circuits to support these patients. 5 Mobile ECMO has developed in recent years at major ECMO programs around the world as a way to facilitate the implementation of ECMO support at hospitals that lack this service, transfer patients on ECMO support from one hospital with lesser resources to institutions with additional capabilities to provide prolonged ECMO support, or provide additional therapies to facilitate weaning off ECMO, and bridge patients to the next therapy. We report a case of mobile ECMO, and discuss the potential application in the current SARS-CoV-2 pandemic. Waiver for the report was provided by our Institutional Review Board, and patient provided written consent for manuscript submission. Although portable ECMO devices present a higher cost than regular ECMO consoles, their smaller size and lighter weight represent important advantages that facilitate the hospital transfer of these patients while the personnel involved can observe maximum contact precautions ( Figure 1 ).

We believe high volume ECMO centers should reconsider restrictive mobile ECMO policies. The establishment of regional mobile ECMO centers would need to involve coordination among hospitals with regard to communication, reciprocity considerations, and bioethics teams. Development of these regional hubs of ECMO expertise with mobile capabilities could offer needed rescue support to patients and provide ideal healthcare services to patients within specific geographical regions.

Brozzi http://orcid.org/0000-0003-2570-324X

World Health Organization Emergency COVID-19 Dashboard

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Extracorporeal Life Support Organization COVID-19 Interim Guidelines: a consensus document from an international group of interdisciplinary ECMO providers

Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings