Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019: Crisis Standards of Care
Cara Agerstrand, Richard E. Dubois, Koji Takeda, Nir Uriel, Philippe Lemaître, J. Fried, Amirali Masoumi, Eva W. Cheung, Yuji Kaku, Lucas Witer, Peter Liou, Claire Gerall, Rafael Klein-Cloud, Darryl Abrams, Jennifer Cunningham, Purnema Madahar, Madhavi Parekh, Briana Short, Natalie Yip, Alexis Serra, Jürgen Beck, Michael Brewer, K. Fung, Dana Mullin, Roy Oommen, B.P. Stanifer, William Middlesworth, Joshua Sonett, Daniel Brodie
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has placed extraordinary strain on global healthcare systems. Use of extracorporeal membrane oxygenation (ECMO) for patients with severe respiratory or cardiac failure attributed to COVID-19 has been debated due to uncertain survival benefit and the resources required to safely deliver ECMO support. We retrospectively investigated adult patients supported with ECMO for COVID-19 at our institution during the first 80 days following New York City's declaration of a state of emergency. The primary objective was to evaluate survival outcomes in patients supported with ECMO for COVID-19 and describe the programmatic adaptations made in response to pandemic-related crisis conditions. Twenty-two patients with COVID-19 were placed on ECMO during the study period. Median age was 52 years and 18 (81.8%) were male. Twenty-one patients (95.4%) had severe ARDS and seven (31.8%) had cardiac failure. Fifteen patients (68.1%) were managed with venovenous ECMO while 7 (31.8%) required arterial support. Twelve patients (54.5%) were transported on ECMO from external institutions. Twelve patients were discharged alive from the hospital (54.5%). Extracorporeal membrane oxygenation was used successfully in patients with respiratory and cardiac failure due to COVID-19. The continued use of ECMO, including ECMO transport, during crisis conditions was possible even at the height of the COVID-19 pandemic.