TY - JOUR
T1 - Extracorporeal Membrane Oxygenation during Respiratory Pandemics Past, Present, and Future
AU - Brodie, Daniel
AU - Abrams, Darryl
AU - MacLaren, Graeme
AU - Brown, Crystal E.
AU - Evans, Laura
AU - Barbaro, Ryan P.
AU - Calfee, Carolyn S.
AU - Hough, Catherine L.
AU - Fowles, Jo Anne
AU - Karagiannidis, Christian
AU - Slutsky, Arthur S.
AU - Combes, Alain
N1 - Publisher Copyright:
Copyright © 2022 by the American Thoracic Society
PY - 2022/6/15
Y1 - 2022/6/15
N2 - 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.
AB - 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.
KW - COVID-19
KW - ECMO
KW - acute respiratory distress syndrome
KW - extracorporeal circulation
KW - respiratory failure
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U2 - 10.1164/rccm.202111-2661CP
DO - 10.1164/rccm.202111-2661CP
M3 - Review article
C2 - 35213298
AN - SCOPUS:85132239879
SN - 1073-449X
VL - 205
SP - 1382
EP - 1390
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 12
ER -