ECMO in COVID-19
Overview
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
NIH released guidelines for treating COVID-19 patients, acknowledging ECMO as a treatment option in the critical care section. https://www.covid19treatmentguidelines.nih.gov/introduction/
ELSO has prepared an in-depth set of guidelines for ECMO in COVID-19 patients. These have been collaboratively developed by a global team of ECMO experts. The guidelines include: patient selection criteria, cannulation and decannulation strategies, transport on ECMO, PPE and staff protection strategies with ECMO, to ethical dilemmas and quality.
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.
Reporting COVID-19 Cases into the ELSO Registry
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 Cases on ECMO in the ELSO Registry:
| Total COVID-19 Cases |
COVID-19
Suspected or Confirmed
3561 |
COVID-19
Confirmed Cases
3547 |
|
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
2631 |
COVID-19
In-hospital Mortality
45% |
| COVID-19 ECMO counts by ELSO Chapter |
| North America | 2318 |
| Europe | 789 |
| Asia Pacific | 55 |
| Latin America | 148 |
| SWAAC | 251 |
|
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
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Disclaimer
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ELSO Ownership, No Rights to Publication, Disclaimer
The Dashboard content has been compiled and reported from a variety of sources, is not independently verified by ELSO, and is subject to change without notice. ELSO and its authorized agents and contractors make no representations or warranties about the quality, content, completeness, suitability, adequacy, sequence, accuracy, or timeliness of such content. ELSO disclaims any responsibility for any inaccuracy, whether by inclusion or omission, on the Dashboard or the Site, and disclaims any responsibility for subsequent change or withdrawal of data shown on the Dashboard or the Site, which is subject to alteration without notice. ELSO disclaims any and all warranties regarding this information and all liability whatsoever relating thereto. Any person who uses information obtained from this Dashboard does so at his or her own risk.
The Dashboard is provided as a public service to facilitate real-time sharing of information during the COVID-19 crisis for educational purposes only by health practitioners. ELSO owns the compilation of all data, and its use or publication by any third party is strictly forbidden. Publication or representation of this information as if it were statistically significant or part of a scientific study is irresponsible and misleading.
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.
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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
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| COVID-19 Critical Care Consortium |
Select Scientific Literature regarding ECMO Use for COVID-19:
- 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
COVID-19 Resource Centers, Scientific Journal Sites
The New England Journal of Medicine: https://www.nejm.org/coronavirus
Journal of American Medical Association: https://jamanetwork.com/journals/jama/pages/coronavirus-alert
Science: https://www.sciencemag.org/coronavirus-research-commentary-and-news?IntCmp=coronavirussiderail-128
The Lancet: https://www.thelancet.com/coronavirus?dgcid=kr_pop-up_tlcoronavirus20
General information regarding
the COVID-19 pandemic can be found at
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
Caregiver Resources
https://www.cstsonline.org/assets/media/documents/CSTS_FS_Sustaining_Well_Being_Healthcare_Personnel_during.pdf
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
Perfusion Task Force
The Joint Perfusion COVID-19 Task Force was assembled recently with the main perfusion professional societies (AmSECT, AACP, ABCP) and additional partners. We are proud to collaborate with all partners working toward the common goal of improving COVID-19 patient outcomes. Please join, if interested, which is free:
https://www.jointperfusiontaskforce.org/
Industry Partners:
Please find the guidance from our industry partners on COVID-19 and ECMO equipment, such as what is currently known about COVID-19 in oxygenators.
Use_of_Getinge_oxygenators_in_Covid19_Internationl Letter.pdf
Getinge_COVID-19_MCP products_US Final_04042020.pdf
Xenios AG Extra Corporeal Life Support (ECLS) products in critically ill patients suffering from COVID-19
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
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.