The National Institute of Health COVID-19 Treatment Guidelines state that there is insufficient data to recommend either for or against routine use of ECMO for patients with refractory hypoxemia. [1]
The Infectious Diseases Society of America does not mention ECMO in their COVID-19 treatment guidelines. [2]
A review article assessing the provision of ECMO services outlines an action plan, detailing special centers to provide ECMO, specific personnel training involved in the ECMO processes, and infection control measures to apply before and after ECMO initiation. [3]
A review summarizing the evidence on ECMO for management of severe acute respiratory distress syndrome (ARDS) during COVID-19 states that veno-venous extracorporeal membrane oxygenation (V-V ECMO) may serve as a rescue therapy for refractory respiratory failure in the setting of acute respiratory compromise induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). [4]
A review assessing the use of ECMO in past respiratory virus outbreaks and its potential role in COVID-19 states it may be considered in patients who develop severe cardiopulmonary failure due to COVID-19 refractory to mechanical ventilation and other medical therapies. Initial reports suggest it has been used in approximately 3% of severe cases with restoration of adequate oxygenation. It was concluded that although ECMO has a role in critically ill patients, there is currently inadequate data to determine the efficacy, optimal patient selection and management of ECMO services. [5]
A review assessing the role of ECMO as a rescue therapy in COVID-19 patients states that ECMO should be reserved for critically ill patients. There may be scope for the use of ECMO as rescue therapy and it should be strongly considered in patients with severe lung injury secondary to COVID‐19.[6]
An article reviewing the existing literature on the role of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the treatment of coronavirus-related cardiovascular collapse concluded that respiratory and mechanical circulatory support can be considered in extreme circumstances. It is recommended to reserve VA-ECMO for highly selected cases of COVID-19 in refractory cardiogenic shock with echocardiographic evidence of reduced biventricular function. [7]