ECMO and COVID-19
As coronavirus disease 2019 (COVID-19) continues its deadly sweep across the globe, the interplay between the role of extracorporeal membrane oxygenation (ECMO) and the management of severely ill patients with COVID-19 who have developed acute respiratory symptoms continues to be examined.
As of August, 3rd, 2020, the entire global population of COVID-19 patients supported with ECMO stood at 2074, 55% of whom were discharged home alive according to the Extracorporeal Life Support Organization (ELSO) Registry. Most (1287 of the COVID-19 patients on ECMO were in North America with 530in Europe, 41 in the Asia Pacific and 89 in South America. Such data from ELSO’s registry provide an overall snapshot of the scope of ECMO use in patients with COVID-19, up to this point.
The increasing number of COVID-19 patients being treated with ECMO therapy explains the recent up tick of interest in Transonic’s Extracorporeal Life Support Assurance (ELSA) Monitor. Inquiries are coming in from every corner of the globe to learn how the ELSA provides clinicians with vital quantitative information to maximize ECMO efficiency. With the ELSA one can verify delivered blood flow, quantify recirculation and measure oxygenator clotting. Knowing actual delivered flow is used to verify circuit flows, determine flows in bridges or shunts and the optimal pump flow setting with any cannula or configuration, and identify tubing flow restrictions or increase pressure within the circuit. Knowing recirculation helps an intensivist adjust cannula position and pump flow to optimize treatment as well as identify low CO due to hypovolemia or heart failure. Measuring and trending oxygenator blood volume to quantify early clot formation in the oxygenator provides a wider window of opportunity to perform oxygenator change-outs.
The ELSO registry is only one way in which ELSO, an international non-profit consortium of health care institutions dedicated to the development and evaluation of therapies for support of failing organ systems, is serving as an important resource and liaison for centers who may be called on to manage COVID-19 patients. To that end, ELSO has dedicated a website https://www.elso.org/COVID19.aspx to ECMO and COVID-19. On the website, one finds a treasure trove of up-to-date information, including the recently released National Institutes of Health (NIH) guidelines for treating COVID-19 patients that acknowledges that ECMO is a viable treatment option in critical care. https://www.covid19treatmentguidelines.nih.gov/introduction/
ELSO’s own in-depth set of guidelines for ECMO in COVID-19 patients, collaboratively developed by a global team of ECMO experts, is also available on the website. The guidelines include: patient selection criteria, cannulation and decannulation strategies, transport on ECMO, PPE and staff protection strategies with ECMO, ethical dilemmas and quality.
In addition, the website has a list of webinars that have been presented about ECMO and COVID-19, a reference list of recent publications and ongoing studies that includes a prospective/retrospective multi-center short period incidence observational study of intensive care unit patients with COVID-19 led by Asia Pacific ELSO leaders as part of the ExtraCorporeal Membrane Oxygenation for 2019 novel Coronavirus Acute Respiratory Disease (COVID-19 Critical Care Consortium.)
For real time updates from ELSO, please follow ELSO’s social media accounts at Twitter (@ELSOOrg and @ECMOed) and Facebook (https://www.facebook.com/ELSO.Org) as well as the ECMOed COVID-19 page (https://elso.blog/category/2019ncov-2/)