Hospitals should have a formal plan to respond to the increasing need for extracorporeal membrane oxygenation (ECMO) in the setting of a pandemic such as COVID-19, according to a study published online April 15 in the Annals of the American Thoracic Society
Raghu Seethala, M.D., and Steven P. Keller, M.D., Ph.D., from Brigham and Women’s Hospital in Boston, present guidelines for ECMO resource planning during a pandemic.
The authors note that criteria for initiating ECMO support must be clearly defined to reduce the burden on ECMO services and enable clinicians to guide expectations and patient management. Preparing guidelines in advance eliminates inconsistency between individual providers. A tiered approach to ECMO response is recommended during a pandemic. During a mild surge, the focus is on increasing capacity by developing specific criteria for initiation and cessation of ECMO; stockpiling equipment; and colocating/regionalizing ECMO patients. Staffing protocols should also be implemented to allow ECMO specialists/nurses to care for more patients, and there should be collaboration with other local and regional ECMO centers. During a moderate surge, the focus should be on allocation of scarce resources by incorporating ECMO initiation decisions into the Hospital Incident Command System framework. During a major surge, ECMO may no longer be offered, and rather, the focus may shift to less resource-intensive therapies that can provide greater benefit for more patients.
“Establishing these guidelines and practice patterns is vital to support the overall mission of preserving the highest number of quality life years for the population as a whole while ensuring equitable care,” the authors write.