Extracorporeal Membrane Oxygenation | ECMO

Extracorporeal Membrane Oxygenation (ECMO) in COVID-19

ELSO COVID-19 Resources

ELSO is providing this website as a resource for centers who may be called on to manage COVID-19 patients. As this is an emerging infectious disease, the scientific data is constantly evolving. The contents of this page will change rapidly as new information develops. For real time updates, 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/)

Guidelines for ECMO in COVID-19

Updated 2021 Guidelines from the Extracorporeal Life Support Organization (ELSO).

Select Scientific Literature regarding ECMO Use for COVID-19:

ELSO Lancet COVID-19 Article

ANN ARBOR, MI - Sept. 25, 2020 - The Extracorporeal Life Support Organization (ELSO) announced today publication in The Lancet of registry findings examining the treatment of COVID-19 patients with extracorporeal membrane oxygenation (ECMO) support. The results show that for ECMO-supported patients with COVID-19, estimated in-hospital mortality 90 days after ECMO and mortality rates in those with a final disposition of death or discharge were under 40 percent.
Full Press Release
The Lancet Article

  • Original Research
    • Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry. Barbaro RP, MacLaren G, Boonstra PS, Iwashyna TJ, Slutsky AS, Fan E, Bartlett RH, Tonna JE, Hyslop R, Fanning JJ, Rycus PT, Hyer SJ, Anders MM, Agerstrand CL, Hryniewicz K, Diaz R, Lorusso R, Combes A, Brodie D; Extracorporeal Life Support Organization. Lancet. 2020 Oct 10;396(10257):1071-1078. doi: 10.1016/S0140-6736(20)32008-0. Epub 2020 Sep 25.PMID: 32987008
    • Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: a retrospective cohort study. Schmidt M, Hajage D, Lebreton G, Monsel A, Voiriot G, Levy D, Baron E, Beurton A, Chommeloux J, Meng P, Nemlaghi S, Bay P, Leprince P, Demoule A, Guidet B, Constantin JM, Fartoukh M, Dres M, Combes A; Groupe de Recherche Clinique en REanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE) Sorbonne Université; Paris-Sorbonne ECMO-COVID investigators. Lancet Respir Med. 2020 Nov;8(11):1121-1131. doi: 10.1016/S2213-2600(20)30328-3. Epub 2020 Aug 13. PMID: 32798468
    • SARS-CoV-2 Does Not Spread Through Extracorporeal Membrane Oxygenation or Dialysis Membranes. Dres M, Burrel S, Boutolleau D, Voiriot G, Demoule A, Combes A, Lebreton G, Schmidt M. Am J Respir Crit Care Med. 2020 Aug 1;202(3):458-460. doi: 10.1164/rccm.202004-1339LE. PMID: 32525400
    • Extracorporeal membrane oxygenation in children with COVID-19: Preliminary report from the collaborative EuroELSO prospective survey. Di Nardo M, Hoskote A, Thiruchelvam T, Lillie J, Horan M, Belda Hofheinz S, Dupic L, Gimeno R, De Piero ME, Lo Coco V, Roeleveld P, Davidson M, Jones T, Broman LM, Lorusso R, Belohlavek J; EuroELSO Neonatal & Pediatric Working Group & collaborators on COVID-19. ASAIO J. 2020 Oct 1. doi: 10.1097/MAT.0000000000001309. Online ahead of print. PMID: 33009172
    • Ventilator-associated pneumonia in patients with SARS-CoV-2-associated acute respiratory distress syndrome requiring ECMO: a retrospective cohort study. Luyt CE, Sahnoun T, Gautier M, Vidal P, Burrel S, Pineton de Chambrun M, Chommeloux J, Desnos C, Arzoine J, Nieszkowska A, Bréchot N, Schmidt M, Hekimian G, Boutolleau D, Robert J, Combes A, Chastre J. Ann Intensive Care. 2020 Nov 23;10(1):158. doi: 10.1186/s13613-020-00775-4. PMID: 33230710
    • Extracorporeal Membrane Oxygenation for Patients With COVID-19 in Severe Respiratory Failure. Mustafa AK, Alexander PJ, Joshi DJ, Tabachnick DR, Cross CA, Pappas PS, Tatooles AJ. JAMA Surg. 2020 Aug 11;155(10):990-2. doi: 10.1001/jamasurg.2020.3950. Online ahead of print. PMID: 32780089
    • Successful Treatment of Pregnant and Postpartum Women with Severe COVID-19 Associated Acute Respiratory Distress Syndrome with Extracorporeal Membrane Oxygenation. Barrantes JH, Ortoleva J, O'Neil ER, Suarez EE, Larson SB, Rali AS, Agerstrand C, Grazioli L, Chatterjee S, Anders M. ASAIO J. 2020 Nov 20. doi: 10.1097/MAT.0000000000001357. Online ahead of print. PMID: 33229971
  • Viewpoints
    • Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases. Ramanathan K, Antognini D, Combes A, Paden M, Zakhary B, Ogino M, MacLaren G, Brodie D, Shekar K. Lancet Respir Med. 2020 May;8(5):518-526. doi: 10.1016/S2213-2600(20)30121-1. Epub 2020 Mar 20. PMID: 32203711
    • Preparing for the Most Critically Ill Patients With COVID-19: The Potential Role of Extracorporeal Membrane Oxygenation. MacLaren G, Fisher D, Brodie D. JAMA. 2020 Apr 7;323(13):1245-1246. doi: 10.1001/jama.2020.2342. PMID: 32074258
    • Provision of ECPR during COVID-19: evidence, equity, and ethical dilemmas. Worku E, Gill D, Brodie D, Lorusso R, Combes A, Shekar K. Crit Care. 2020 Jul 27;24(1):462. doi: 10.1186/s13054-020-03172-2.PMID: 32718340
    • What's new in ECMO for COVID-19? MacLaren G, Combes A, Brodie D. Intensive Care Med. 2020 Nov 12:1-3. doi: 10.1007/s00134-020-06284-z. Online ahead of print. PMID: 33180168
    • ECMO during the COVID-19 pandemic: when is it unjustified? Abrams D, Lorusso R, Vincent JL, Brodie D. Crit Care. 2020 Aug 17;24(1):507. doi: 10.1186/s13054-020-03230-9. PMID 32807189
    • ECMO for severe ARDS associated with COVID-19: now we know we can, but should we? Shekar K, Slutsky AS, Brodie D. Lancet Respir Med. 2020 Nov;8(11):1066-1068. doi: 10.1016/S2213-2600(20)30357-X. Epub 2020 Aug 13. PMID: 32798470
    • COVID-19 and ECMO: the interplay between coagulation and inflammation-a narrative review. Kowalewski M, Fina D, Słomka A, Raffa GM, Martucci G, Lo Coco V, De Piero ME, Ranucci M, Suwalski P, Lorusso R. Crit Care. 2020 May 8;24(1):205. doi: 10.1186/s13054-020-02925-3.PMID: 32384917
    • COVID-19-associated acute respiratory distress syndrome: is a different approach to management warranted? Fan E, Beitler JR, Brochard L, Calfee CS, Ferguson ND, Slutsky AS, Brodie D. Lancet Respir Med. 2020 Aug;8(8):816-821. doi: 10.1016/S2213-2600(20)30304-0. Epub 2020 Jul 6.PMID: 32645311
    • Extracorporeal life support for adults with acute respiratory distress syndrome. Combes A, Schmidt M, Hodgson CL, Fan E, Ferguson ND, Fraser JF, Jaber S, Pesenti A, Ranieri M, Rowan K, Shekar K, Slutsky AS, Brodie D. Intensive Care Med. 2020 Dec;46(12):2464-2476. doi: 10.1007/s00134-020-06290-1. Epub 2020 Nov 2.PMID: 33140180

Special Discussion

Guidance Document

Initial ELSO Guidance Document – published in the ASAIO Journal:

https://journals.lww.com/asaiojournal/Fulltext/2020/05000/Initial_ELSO_Guidance_Document__ECMO_for_COVID_19.3.aspx

We are pleased to release ELSO`s Guidance on ECMO in COVID-19. This document has been approved by the Executive Committee and Chapter Chairs. It will be updated as necessary.

 

 

Messages from ELSO’s President on COVID-19

An Update on ECMO in COVID19 from ELSO’s President, Dr. Mark Ogino.
Posted May 4, 2020.

ELSO's response to COVID-19 from ELSO's President, Dr. Mark Ogino. The use of ECMO in treating COVID-19 patients.
Posted March 14, 2020.

Reporting COVID-19 Cases into the ELSO Registry

COVID-19 Cases on ECMO in the ELSO Registry:

Total COVID-19 Cases COVID-19
Suspected or Confirmed
9186
COVID-19
Confirmed Cases
9153
Total counts of COVID-19 confirmed patients and count of COVID-19 suspected but not confirmed by testing.
Patients who initiated ECMO at
least 90 days ago
COVID-19
Confirmed
7605
COVID-19
In-hospital Mortality
48%
COVID-19 ECMO counts by ELSO Chapter
North America 5858
Europe 1985
Asia Pacific 134
Latin America 618
SWAAC 591
Reports counts of ECMO-supported suspected or confirmed COVID-19 cases by ELSO Chapter (provided the chapter has at least 5 cases reported)
FULL COVID-19 REGISTRY DASHBOARD

Disclaimer

Reporting COVID-19 Cases into the ELSO Registry

Confirmed COVID-19 cases should utilize the ICD-10 emergency code U07.1, 2019-nCoV acute respiratory disease as the primary diagnosis. In an effort to better understand the impact of COVID-19 on ECMO we have also added a question asking if a patient has COVID-19.

There are 4 response options:

  • COVID-19 confirmed by testing 

  • COVID-19 suspected but NO testing 

  • No clinical suspicion of COVID-19 (and no testing) 

  • COVID-19 confirmed negative 


ECMO Related COVID-19 Research

COVID-19 Critical Care Consortium

ExtraCorporeal Membrane Oxygenation for 2019 novel Coronavirus Acute Respiratory Disease (COVID-19 Critical Care Consortium) is a prospective/retrospective multi-center short period incidence observational study of intensive care unit patients with COVID-19. 

COVID-19 Critical Care Consortium

Euro-ELSO

EuroELSO has established a COVID-19 survey and has released results. This is an ongoing effort in the region and we will continue to update this section as more results become available.

Euro-ELSO Survey


FDA Approves ECMO Use for Equipment During Pandemic

FDA released guidance for industry and FDA staff on Enforcement Policy for Extracorporeal Membrane Oxygenation and Cardiopulmonary Bypass Devices During the Coronavirus Disease 2019 (COVID-19) Public Health Emergency.
https://www.fda.gov/media/136734/download

News Media

The Rationing of a Last-Resort Covid Treatment in NYT:

https://www.nytimes.com/2021/07/12/us/covid-treatment-ecmo.html?smid=url-share

https://www.nytimes.com/2020/04/26/health/coronavirus-patient-ventilator.html?action=click&module=Spotlight&pgtype=Homepage

https://www.npr.org/sections/health-shots/2021/09/06/1033832562/covid-icu-ecmo-life-support-shortage-hospitals

News article on treating COVID-19 patients with ECMO, referencing Michigan Medicine, Dr. Bartlett, and current ECMO Director Jonathan Haft: https://www.wxyz.com/news/coronavirus/rare-life-support-system-pioneered-by-u-of-m-doctor-helps-covid-19-patients

Use of ECMO in COVID-19 patients, ELSO, and history of ECMO: https://labblog.uofmhealth.org/rounds/when-ventilators-dont-help-covid-19-patients-might

https://www.wxyz.com/news/coronavirus/rare-life-support-system-pioneered-by-u-of-m-doctor-helps-covid-19-patients

In Critical Coronavirus Cases, Doctors Turn to Last-Ditch Lung Support – WSJ

https://www.washingtonpost.com/outlook/2020/04/14/coronavirus-heart-lung-bypass/

https://www.nbcnews.com/news/us-news/46-year-old-doctor-coronavirus-was-critically-ill-made-startling-n1208641

A ventilator wasn't enough to treat him for Covid-19. This machine became his last chance for survival

Doctors in Arizona doubted that Dr. Karl Viddal was going to make it. The ventilator was running at its highest setting and still wasn't enough for his lungs.

Read in CNN: https://apple.news/AVyULfn_1ST-KmMYXmRG2vA

https://www.thestar.com/news/gta/2020/06/14/covid-19-was-killing-him-how-a-last-resort-intervention-brought-this-toronto-man-back-from-the-brink.html

“Father of ECMO: When a Ventilator Isn’t Enough”:
https://www.medscape.com/viewarticle/934404?nlid=136562_530&src=WNL_mdplsfeat_200728_mscpedit_ccmd&uac=261132HN&spon=32&impID=2480721&faf=1#vp_1

Inside the Fight to Save Houston’s Most Vulnerable https://www.nytimes.com/interactive/2020/08/10/us/houston-hospital-coronavirus.html?referringSource=articleShare

Extracorporeal organs could save the sickest patients from Covid-19 https://www.medicaldevice-network.com/features/ecmo-covid-19-2/

https://health.usnews.com/conditions/coronavirus-and-your-health/articles/what-is-ecmo-for-covid-19

https://www.2minutemedicine.com/visualabstract-outcomes-of-covid-19-related-ards-patients-on-extracorporeal-membrane-oxygenation/

https://www.healthleadersmedia.com/welcome-ad?toURL=/clinical-care/mortality-data-supports-placing-seriously-ill-coronavirus-patients-ecmo

https://news.umich.edu/last-resort-life-support-option-helped-majority-of-critically-ill-covid-19-patients-survive/

https://labblog.uofmhealth.org/health-tech/ecmo-last-resort-life-support-option-helped-majority-of-critically-ill-covid-19

https://www.latimes.com/california/story/2021-03-12/covid-19-ecmo-breathing-machine-blanca-lopez

https://www.nytimes.com/2021/06/03/health/covid-19-diagnosis-surgeon.html?campaign_id=9&emc=edit_nn_20210604&instance_id=32233&nl=the-morning®i_id=51062027&segment_id=59837&te=1&user_id=902dc21426e33506108db3a001d4572d

ECMO in COVID-19 infection

The WHO is distributing an Interim Guidance document for the
"Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected. ( https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected) " The WHO guidance document includes a statement to "consider referral patients with refractory hypoxemia despite lung-protective ventilation in settings with access to expertise in ECLS." Similarly, the United States Center for Disease Control provides interim guidance ( https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html ) for clinical management of COVID-19 patients with and without acute respiratory distress syndrome (ARDS). Where ECLS expertise is available, ECLS should be considered according to the standard management algorithm for ARDS in supporting patients with viral lower respiratory tract infection. However, clearly, at this time, there is little worldwide experience with using ECLS to support COVID-19 patients. ELSO leaders have discussed the potential role of ECMO for COVID-19 patients in a recent Journal of the American Medical Association Viewpoint ( https://jamanetwork.com/journals/jama/articlepdf/2761778/jama_maclaren_2020_vp_200024.pdf ). ELSO will continue to collect data through our member centers through the ELSO Registry and provide recommendations as additional information becomes available.

Webinars & Podcasts

Webinar:

Critical care & ECMO in the era of COVID-19: why data matters


On Jun 08, 2020 ELSO hosted a webinar: 'Critical care & ECMO in the era of COVID-19: why data matters'. Critical care & ECMO in the era of COVID-19: why data matters! ELSO webinar, moderated by Dr. Robert Bartlett & Matt Paden, highlighting the current research underway focused on better understanding the impact of COVID-19, and the role of extracorporeal support and ICU care in patients with SARS-CoV-2 Coronavirus infection. Topics & speakers: ELSO Registry and the live dashboard for COVID-19 Cases: Matt Paden & Ryan Barbaro EuroELSO Survey on ECLS in COVID-19, Roberto Lorusso & Jan Bělohlávek COVID-Critical Care Consortium, John Fraser & Heidi Dalton

On April 22, 2020 ELSO hosted a webinar ‘ECMO COVID-19 What we have learned.’ Speakers & topics: Christian Bermudez - ECMO Center Organization and Regional Coordination; Holt Murray - Regional ECMO Coordination; 10 years in 10 minutes Erik Osborn - COVID-19 & ECMO Experiences & Management; Tim Maul - Inflammation & Coagulation for SARS-CoV-2 a Perfusionist’s Perspective; Troy Seelhammer - ECMO in COVID-19: Is There a Role for Bivalirudin? All slides available at https://bit.ly/2RZpAHc

Watch the STS Webinar from Thursday, April 23rd - Webinar on COVID Crisis

Cardiothoracic surgeons around the globe quickly adapted to the challenges presented by the COVID pandemic. Among the issues has been an increased need for extracorporeal membrane oxygenation (ECMO), without the required resources to meet the demand.

Explain the role of the Extracorporeal Life Support Organization (ELSO) in guiding physicians and other practitioners through preparations for the COVID pandemic.


On Friday, April 3rd, 2020 at 4:00pm Eastern ELSO hosted a webinar: The Power of Connection. In that webinar, we discussed the power of sharing information in real-time using WhatsApp COVID19 chat rooms so that we can share what we are learning about COVID-19 patients on ECMO quickly (Tammy Friedrich, Holli Williams, Amy Hackman). We also shared the experiences with COVID-19 patients on ECMO in Seattle (Jenelle Badulak), NYC (Cara Agerstrand), and Paris (Matthieu Schmidt). You can view the webinar anytime above.




Preparing to support #COVID19 patients on #ECMO: first ELSO webinar dedicated to the role of extracorporeal support in patients with #SARSCoV2 infection, speakers:
Dr. Ram Ramanathan
Dr. Kiran Shekar
Dr. Michael Matthay

We’ve updated our Privacy Policy. By continuing to use this Service, you acknowledge you’ve read the updated Privacy Policy.

(https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected)" The WHO guidance document includes a statement to "consider referral patients with refractory hypoxemia despite lung-protective ventilation in settings with access to expertise in ECLS." Similarly, the United States Center for Disease Control provides interim guidance (https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html) for clinical management of COVID-19 patients with and without acute respiratory distress syndrome (ARDS). Where ECLS expertise is available, ECLS should be considered according to the standard management algorithm for ARDS in supporting patients with viral lower respiratory tract infection. However, clearly, at this time, there is little worldwide experience with using ECLS to support COVID-19 patients. ELSO leaders have discussed the potential role of ECMO for COVID-19 patients in a recent Journal of the American Medical Association Viewpoint (https://jamanetwork.com/journals/jama/articlepdf/2761778/jama_maclaren_2020_vp_200024.pdf). ELSO will continue to collect data through our member centers through the ELSO Registry and provide recommendations as additional information becomes available.

Extracorporeal Membrane Oxygenation | ECMO

Extracorporeal Membrane Oxygenation (ECMO) in COVID-19

ELSO COVID-19 Resources

ELSO is providing this website as a resource for centers who may be called on to manage COVID-19 patients. As this is an emerging infectious disease, the scientific data is constantly evolving. The contents of this page will change rapidly as new information develops. For real time updates, 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/)

COVID-19 Cases on ECMO in the ELSO Registry:

Total COVID-19 Cases COVID-19
Suspected or Confirmed
9186
COVID-19
Confirmed Cases
9153
Total counts of COVID-19 confirmed patients and count of COVID-19 suspected but not confirmed by testing.
Patients who initiated ECMO at
least 90 days ago
COVID-19
Confirmed
7605
COVID-19
In-hospital Mortality
48%
COVID-19 ECMO counts by ELSO Chapter
North America 5858
Europe 1985
Asia Pacific 134
Latin America 618
SWAAC 591
Reports counts of ECMO-supported suspected or confirmed COVID-19 cases by ELSO Chapter (provided the chapter has at least 5 cases reported)
FULL COVID-19 REGISTRY DASHBOARD

Disclaimer

Reporting COVID-19 Cases into the ELSO Registry

Confirmed COVID-19 cases should utilize the ICD-10 emergency code U07.1, 2019-nCoV acute respiratory disease as the primary diagnosis. In an effort to better understand the impact of COVID-19 on ECMO we have also added a question asking if a patient has COVID-19.

There are 4 response options:

  • COVID-19 confirmed by testing 

  • COVID-19 suspected but NO testing 

  • No clinical suspicion of COVID-19 (and no testing) 

  • COVID-19 confirmed negative 


Guidelines for ECMO in COVID-19

Updated 2021 Guidelines from the Extracorporeal Life Support Organization (ELSO).

ECMO Related COVID-19 Research

COVID-19 Critical Care Consortium

ExtraCorporeal Membrane Oxygenation for 2019 novel Coronavirus Acute Respiratory Disease (COVID-19 Critical Care Consortium) is a prospective/retrospective multi-center short period incidence observational study of intensive care unit patients with COVID-19. 

COVID-19 Critical Care Consortium

Euro-ELSO

EuroELSO has established a COVID-19 survey and has released results. This is an ongoing effort in the region and we will continue to update this section as more results become available.

Euro-ELSO Survey

Select Scientific Literature regarding ECMO Use for COVID-19:

ELSO Lancet COVID-19 Article

ANN ARBOR, MI - Sept. 25, 2020 - The Extracorporeal Life Support Organization (ELSO) announced today publication in The Lancet of registry findings examining the treatment of COVID-19 patients with extracorporeal membrane oxygenation (ECMO) support. The results show that for ECMO-supported patients with COVID-19, estimated in-hospital mortality 90 days after ECMO and mortality rates in those with a final disposition of death or discharge were under 40 percent.
Full Press Release
The Lancet Article

  • Original Research
    • Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry. Barbaro RP, MacLaren G, Boonstra PS, Iwashyna TJ, Slutsky AS, Fan E, Bartlett RH, Tonna JE, Hyslop R, Fanning JJ, Rycus PT, Hyer SJ, Anders MM, Agerstrand CL, Hryniewicz K, Diaz R, Lorusso R, Combes A, Brodie D; Extracorporeal Life Support Organization. Lancet. 2020 Oct 10;396(10257):1071-1078. doi: 10.1016/S0140-6736(20)32008-0. Epub 2020 Sep 25.PMID: 32987008
    • Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: a retrospective cohort study. Schmidt M, Hajage D, Lebreton G, Monsel A, Voiriot G, Levy D, Baron E, Beurton A, Chommeloux J, Meng P, Nemlaghi S, Bay P, Leprince P, Demoule A, Guidet B, Constantin JM, Fartoukh M, Dres M, Combes A; Groupe de Recherche Clinique en REanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE) Sorbonne Université; Paris-Sorbonne ECMO-COVID investigators. Lancet Respir Med. 2020 Nov;8(11):1121-1131. doi: 10.1016/S2213-2600(20)30328-3. Epub 2020 Aug 13. PMID: 32798468
    • SARS-CoV-2 Does Not Spread Through Extracorporeal Membrane Oxygenation or Dialysis Membranes. Dres M, Burrel S, Boutolleau D, Voiriot G, Demoule A, Combes A, Lebreton G, Schmidt M. Am J Respir Crit Care Med. 2020 Aug 1;202(3):458-460. doi: 10.1164/rccm.202004-1339LE. PMID: 32525400
    • Extracorporeal membrane oxygenation in children with COVID-19: Preliminary report from the collaborative EuroELSO prospective survey. Di Nardo M, Hoskote A, Thiruchelvam T, Lillie J, Horan M, Belda Hofheinz S, Dupic L, Gimeno R, De Piero ME, Lo Coco V, Roeleveld P, Davidson M, Jones T, Broman LM, Lorusso R, Belohlavek J; EuroELSO Neonatal & Pediatric Working Group & collaborators on COVID-19. ASAIO J. 2020 Oct 1. doi: 10.1097/MAT.0000000000001309. Online ahead of print. PMID: 33009172
    • Ventilator-associated pneumonia in patients with SARS-CoV-2-associated acute respiratory distress syndrome requiring ECMO: a retrospective cohort study. Luyt CE, Sahnoun T, Gautier M, Vidal P, Burrel S, Pineton de Chambrun M, Chommeloux J, Desnos C, Arzoine J, Nieszkowska A, Bréchot N, Schmidt M, Hekimian G, Boutolleau D, Robert J, Combes A, Chastre J. Ann Intensive Care. 2020 Nov 23;10(1):158. doi: 10.1186/s13613-020-00775-4. PMID: 33230710
    • Extracorporeal Membrane Oxygenation for Patients With COVID-19 in Severe Respiratory Failure. Mustafa AK, Alexander PJ, Joshi DJ, Tabachnick DR, Cross CA, Pappas PS, Tatooles AJ. JAMA Surg. 2020 Aug 11;155(10):990-2. doi: 10.1001/jamasurg.2020.3950. Online ahead of print. PMID: 32780089
    • Successful Treatment of Pregnant and Postpartum Women with Severe COVID-19 Associated Acute Respiratory Distress Syndrome with Extracorporeal Membrane Oxygenation. Barrantes JH, Ortoleva J, O'Neil ER, Suarez EE, Larson SB, Rali AS, Agerstrand C, Grazioli L, Chatterjee S, Anders M. ASAIO J. 2020 Nov 20. doi: 10.1097/MAT.0000000000001357. Online ahead of print. PMID: 33229971
  • Viewpoints
    • Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases. Ramanathan K, Antognini D, Combes A, Paden M, Zakhary B, Ogino M, MacLaren G, Brodie D, Shekar K. Lancet Respir Med. 2020 May;8(5):518-526. doi: 10.1016/S2213-2600(20)30121-1. Epub 2020 Mar 20. PMID: 32203711
    • Preparing for the Most Critically Ill Patients With COVID-19: The Potential Role of Extracorporeal Membrane Oxygenation. MacLaren G, Fisher D, Brodie D. JAMA. 2020 Apr 7;323(13):1245-1246. doi: 10.1001/jama.2020.2342. PMID: 32074258
    • Provision of ECPR during COVID-19: evidence, equity, and ethical dilemmas. Worku E, Gill D, Brodie D, Lorusso R, Combes A, Shekar K. Crit Care. 2020 Jul 27;24(1):462. doi: 10.1186/s13054-020-03172-2.PMID: 32718340
    • What's new in ECMO for COVID-19? MacLaren G, Combes A, Brodie D. Intensive Care Med. 2020 Nov 12:1-3. doi: 10.1007/s00134-020-06284-z. Online ahead of print. PMID: 33180168
    • ECMO during the COVID-19 pandemic: when is it unjustified? Abrams D, Lorusso R, Vincent JL, Brodie D. Crit Care. 2020 Aug 17;24(1):507. doi: 10.1186/s13054-020-03230-9. PMID 32807189
    • ECMO for severe ARDS associated with COVID-19: now we know we can, but should we? Shekar K, Slutsky AS, Brodie D. Lancet Respir Med. 2020 Nov;8(11):1066-1068. doi: 10.1016/S2213-2600(20)30357-X. Epub 2020 Aug 13. PMID: 32798470
    • COVID-19 and ECMO: the interplay between coagulation and inflammation-a narrative review. Kowalewski M, Fina D, Słomka A, Raffa GM, Martucci G, Lo Coco V, De Piero ME, Ranucci M, Suwalski P, Lorusso R. Crit Care. 2020 May 8;24(1):205. doi: 10.1186/s13054-020-02925-3.PMID: 32384917
    • COVID-19-associated acute respiratory distress syndrome: is a different approach to management warranted? Fan E, Beitler JR, Brochard L, Calfee CS, Ferguson ND, Slutsky AS, Brodie D. Lancet Respir Med. 2020 Aug;8(8):816-821. doi: 10.1016/S2213-2600(20)30304-0. Epub 2020 Jul 6.PMID: 32645311
    • Extracorporeal life support for adults with acute respiratory distress syndrome. Combes A, Schmidt M, Hodgson CL, Fan E, Ferguson ND, Fraser JF, Jaber S, Pesenti A, Ranieri M, Rowan K, Shekar K, Slutsky AS, Brodie D. Intensive Care Med. 2020 Dec;46(12):2464-2476. doi: 10.1007/s00134-020-06290-1. Epub 2020 Nov 2.PMID: 33140180

FDA Approves ECMO Use for Equipment During Pandemic

FDA released guidance for industry and FDA staff on Enforcement Policy for Extracorporeal Membrane Oxygenation and Cardiopulmonary Bypass Devices During the Coronavirus Disease 2019 (COVID-19) Public Health Emergency.
https://www.fda.gov/media/136734/download

Special Discussion

News Media

The Rationing of a Last-Resort Covid Treatment in NYT:

https://www.nytimes.com/2021/07/12/us/covid-treatment-ecmo.html?smid=url-share

https://www.nytimes.com/2020/04/26/health/coronavirus-patient-ventilator.html?action=click&module=Spotlight&pgtype=Homepage

News article on treating COVID-19 patients with ECMO, referencing Michigan Medicine, Dr. Bartlett, and current ECMO Director Jonathan Haft: https://www.wxyz.com/news/coronavirus/rare-life-support-system-pioneered-by-u-of-m-doctor-helps-covid-19-patients

Use of ECMO in COVID-19 patients, ELSO, and history of ECMO: https://labblog.uofmhealth.org/rounds/when-ventilators-dont-help-covid-19-patients-might

https://www.wxyz.com/news/coronavirus/rare-life-support-system-pioneered-by-u-of-m-doctor-helps-covid-19-patients

In Critical Coronavirus Cases, Doctors Turn to Last-Ditch Lung Support – WSJ

https://www.washingtonpost.com/outlook/2020/04/14/coronavirus-heart-lung-bypass/

https://www.nbcnews.com/news/us-news/46-year-old-doctor-coronavirus-was-critically-ill-made-startling-n1208641

A ventilator wasn't enough to treat him for Covid-19. This machine became his last chance for survival

Doctors in Arizona doubted that Dr. Karl Viddal was going to make it. The ventilator was running at its highest setting and still wasn't enough for his lungs.

Read in CNN: https://apple.news/AVyULfn_1ST-KmMYXmRG2vA

https://www.thestar.com/news/gta/2020/06/14/covid-19-was-killing-him-how-a-last-resort-intervention-brought-this-toronto-man-back-from-the-brink.html

“Father of ECMO: When a Ventilator Isn’t Enough”:
https://www.medscape.com/viewarticle/934404?nlid=136562_530&src=WNL_mdplsfeat_200728_mscpedit_ccmd&uac=261132HN&spon=32&impID=2480721&faf=1#vp_1

Inside the Fight to Save Houston’s Most Vulnerable https://www.nytimes.com/interactive/2020/08/10/us/houston-hospital-coronavirus.html?referringSource=articleShare

Extracorporeal organs could save the sickest patients from Covid-19 https://www.medicaldevice-network.com/features/ecmo-covid-19-2/

https://health.usnews.com/conditions/coronavirus-and-your-health/articles/what-is-ecmo-for-covid-19

https://www.2minutemedicine.com/visualabstract-outcomes-of-covid-19-related-ards-patients-on-extracorporeal-membrane-oxygenation/

https://www.healthleadersmedia.com/welcome-ad?toURL=/clinical-care/mortality-data-supports-placing-seriously-ill-coronavirus-patients-ecmo

https://news.umich.edu/last-resort-life-support-option-helped-majority-of-critically-ill-covid-19-patients-survive/

https://labblog.uofmhealth.org/health-tech/ecmo-last-resort-life-support-option-helped-majority-of-critically-ill-covid-19

https://www.latimes.com/california/story/2021-03-12/covid-19-ecmo-breathing-machine-blanca-lopez

https://www.nytimes.com/2021/06/03/health/covid-19-diagnosis-surgeon.html?campaign_id=9&emc=edit_nn_20210604&instance_id=32233&nl=the-morning®i_id=51062027&segment_id=59837&te=1&user_id=902dc21426e33506108db3a001d4572d

ECMO in COVID-19 infection

The WHO is distributing an Interim Guidance document for the
"Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected. ( https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected) " The WHO guidance document includes a statement to "consider referral patients with refractory hypoxemia despite lung-protective ventilation in settings with access to expertise in ECLS." Similarly, the United States Center for Disease Control provides interim guidance ( https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html ) for clinical management of COVID-19 patients with and without acute respiratory distress syndrome (ARDS). Where ECLS expertise is available, ECLS should be considered according to the standard management algorithm for ARDS in supporting patients with viral lower respiratory tract infection. However, clearly, at this time, there is little worldwide experience with using ECLS to support COVID-19 patients. ELSO leaders have discussed the potential role of ECMO for COVID-19 patients in a recent Journal of the American Medical Association Viewpoint ( https://jamanetwork.com/journals/jama/articlepdf/2761778/jama_maclaren_2020_vp_200024.pdf ). ELSO will continue to collect data through our member centers through the ELSO Registry and provide recommendations as additional information becomes available.

Messages from ELSO’s President on COVID-19

An Update on ECMO in COVID19 from ELSO’s President, Dr. Mark Ogino.
Posted May 4, 2020.

ELSO's response to COVID-19 from ELSO's President, Dr. Mark Ogino. The use of ECMO in treating COVID-19 patients.
Posted March 14, 2020.

Webinars & Podcasts

Webinar:

Critical care & ECMO in the era of COVID-19: why data matters


On Jun 08, 2020 ELSO hosted a webinar: 'Critical care & ECMO in the era of COVID-19: why data matters'. Critical care & ECMO in the era of COVID-19: why data matters! ELSO webinar, moderated by Dr. Robert Bartlett & Matt Paden, highlighting the current research underway focused on better understanding the impact of COVID-19, and the role of extracorporeal support and ICU care in patients with SARS-CoV-2 Coronavirus infection. Topics & speakers: ELSO Registry and the live dashboard for COVID-19 Cases: Matt Paden & Ryan Barbaro EuroELSO Survey on ECLS in COVID-19, Roberto Lorusso & Jan Bělohlávek COVID-Critical Care Consortium, John Fraser & Heidi Dalton

On April 22, 2020 ELSO hosted a webinar ‘ECMO COVID-19 What we have learned.’ Speakers & topics: Christian Bermudez - ECMO Center Organization and Regional Coordination; Holt Murray - Regional ECMO Coordination; 10 years in 10 minutes Erik Osborn - COVID-19 & ECMO Experiences & Management; Tim Maul - Inflammation & Coagulation for SARS-CoV-2 a Perfusionist’s Perspective; Troy Seelhammer - ECMO in COVID-19: Is There a Role for Bivalirudin? All slides available at https://bit.ly/2RZpAHc

Watch the STS Webinar from Thursday, April 23rd - Webinar on COVID Crisis

Cardiothoracic surgeons around the globe quickly adapted to the challenges presented by the COVID pandemic. Among the issues has been an increased need for extracorporeal membrane oxygenation (ECMO), without the required resources to meet the demand.

Explain the role of the Extracorporeal Life Support Organization (ELSO) in guiding physicians and other practitioners through preparations for the COVID pandemic.


On Friday, April 3rd, 2020 at 4:00pm Eastern ELSO hosted a webinar: The Power of Connection. In that webinar, we discussed the power of sharing information in real-time using WhatsApp COVID19 chat rooms so that we can share what we are learning about COVID-19 patients on ECMO quickly (Tammy Friedrich, Holli Williams, Amy Hackman). We also shared the experiences with COVID-19 patients on ECMO in Seattle (Jenelle Badulak), NYC (Cara Agerstrand), and Paris (Matthieu Schmidt). You can view the webinar anytime above.




Preparing to support #COVID19 patients on #ECMO: first ELSO webinar dedicated to the role of extracorporeal support in patients with #SARSCoV2 infection, speakers:
Dr. Ram Ramanathan
Dr. Kiran Shekar
Dr. Michael Matthay