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Extracorporeal Membrane Oxygenation

Last Updated: April 21, 2020

Recommendation:

  • There are insufficient data to recommend either for or against the routine use of extracorporeal membrane oxygenation (ECMO) for patients with COVID-19 and refractory hypoxemia (BIII).

Rationale

While ECMO may serve as an effective short-term rescue therapy in patients with severe acute respiratory distress syndrome and refractory hypoxemia, there is no conclusive evidence that ECMO is responsible for better clinical outcomes in patients who received ECMO than in patients who did not receive ECMO.1-4

ECMO is used by some experts, when available, for patients with refractory hypoxemia despite optimization of ventilation strategies and adjunctive therapies. Ideally, clinicians who are interested in using ECMO should either try to enter their patient into clinical trials or clinical registries so that more informative data can be obtained. The following resources provide more information on the use of ECMO in patients with COVID-19:

References

  1. Peek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374(9698):1351-1363. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19762075.
  2. Pham T, Combes A, Roze H, et al. Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis. Am J Respir Crit Care Med. 2013;187(3):276-285. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23155145.
  3. Harrington D, Drazen JM. Learning from a by a and board. N Engl J Med. 2018;378(21):2031-2032. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29791830.
  4. Munshi L, Walkey A, Goligher E, Pham T, Uleryk EM, Fan E. Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis. Lancet Respir Med. 2019;7(2):163-172. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30642776.