J Crit Care . Veno-venous extracorporeal membrane oxygenation allocation in the COVID-19 pandemic

[tetano]

J Crit Care


. 2020 Nov 13;61:221-226.
doi: 10.1016/j.jcrc.2020.11.004. Online ahead of print.
Veno-venous extracorporeal membrane oxygenation allocation in the COVID-19 pandemic


Kadhiresan R Murugappan ¹ , Daniel P Walsh ² , Aaron Mittel ³ , David Sontag ⁴ , Shahzad Shaefi ²



Affiliations

• PMID: 33220575
• DOI: 10.1016/j.jcrc.2020.11.004

Abstract

Rapid global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the resultant clinical illness, coronavirus disease 2019 (COVID-19), drove the World Health Organization to declare COVID-19 a pandemic. Veno-venous Extra-Corporeal Membrane Oxygenation (VV-ECMO) is an established therapy for management of patients demonstrating the most severe forms of hypoxemic respiratory failure from COVID-19. However, features of COVID-19 pathophysiology and necessary length of treatment present distinct challenges for utilization of VV-ECMO within the current healthcare emergency. In addition, growing allocation concerns due to capacity and cost present significant challenges. Ethical and legal aspects pertinent to triage of this resource-intensive, but potentially life-saving, therapy in the setting of the COVID-19 pandemic are reviewed here. Given considerations relevant to VV-ECMO use, additional emphasis has been placed on emerging hospital resource scarcity and disproportionate representation of healthcare workers among the ill. Considerations are also discussed surrounding withdrawal of VV-ECMO and the role for early communication as well as consultation from palliative care teams and local ethics committees. In discussing how to best manage these issues in the COVID-19 pandemic at present, we identify gaps in the literature and policy important to clinicians as this crisis continues.

Keywords: COVID-19; Coronavirus; Ethics; Extracorporeal life support; Resource allocation.