(Dr. S.N. Misra – 17th July, 2020)
Extracorporeal membrane oxygenation (ECMO), is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequate amount of gas exchange or perfusion to sustain life. ECMO was developed in the 1950s by John Gibbon, and then by C. Walton Lillehei. ECMO works by temporarily drawing blood from the body to allow artificial oxygenation of the red blood cells and removal of carbon dioxide. ECMO is now being used to support patients with the acute viral pneumonia associated with COVID-19 in cases where artificial ventilation is not sufficient to sustain blood oxygenation levels.
In early February 2020, doctors in China have increasingly been using ECMO as an adjunct support for patients presenting with acute viral pneumonia associated with COVID-19 infection, when, even after ventilation, the blood oxygenation levels remain too low to sustain the patient. The initial reports indicate that it is assisting in restoring patients’ blood oxygen saturation and reducing fatalities among the approximately 3% of severe cases where it has been utilized. For critically ill patients, the mortality rate reduces from around 59-71% with conventional therapy to approximately 46% with ECMO.
Support with ECMO is further not available in many low- and middle-income countries; therefore, ECMO might not seem to gain as much of a priority as personal protective equipment, correct management, diagnosis and quarantine, oxygen therapy alone, and mechanical ventilation in first stance.
Reproduced from – Kowalewski, M., Fina, D., Słomka, A. et al. COVID-19 and ECMO: the interplay between coagulation and inflammation—a narrative review. Crit Care 24, 205 (2020). https://doi.org/10.1186/s13054-020-02925-3 Doi: https://rdcu.be/b5E5fMany other studies appear inconclusive in their recommendations to the use of ECMO in severe cases of COVID 19.
ECMO is a resource-intensive form of life support that can be used as a rescue therapy in critical patients. ECMO could be of use in COVID-19 patients with severe ARDS or cardiomyopathy in which conventional therapy has failed.
Pravda NS, Pravda MS, Kornowski R, Orvin K. Extracorporeal membrane oxygenation therapy in the COVID-19 pandemic [published online ahead of print, 2020 Apr 17]. Future Cardiol. 2020;10.2217/fca-2020-0040. Doi: https://dx.doi.org/10.2217%2Ffca-2020-0040
In COVID-19, the decision-making is even more complex than usual. But with limited evidence to back their use and the amount of resources required, physicians on the front lines are urging a go-slow approach