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

Daniel Brodie, Darryl Abrams, Graeme MacLaren, Crystal E. Brown, Laura Evans, Ryan P. Barbaro, Carolyn S. Calfee, Catherine L. Hough, Jo Anne Fowles, Christian Karagiannidis, Arthur S. Slutsky, Alain Combes

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1382-1390
Number of pages9
JournalAmerican journal of respiratory and critical care medicine
Volume205
Issue number12
DOIs
StatePublished - Jun 15 2022

Keywords

  • COVID-19
  • ECMO
  • acute respiratory distress syndrome
  • extracorporeal circulation
  • respiratory failure

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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