Surging Role of Extracorporeal Membrane Oxygenation in Refractory ARDS Due COVID-19 and In-depth Review of Existing Applications

Abstract

Introduction: Extra Corporeal Membrane Oxygenation (ECMO) is a device applied to maintain cardiopulmonary support in patients in whom there is a failure of the cardiopulmonary function to maintain perfusion to vital organs. Previously, ECMO was used in pulmonary embolism, cardiogenic shock, myocarditis, and heart failure cases. Its use in refractory acute respiratory distress syndrome (ARDS) in coronavirus disease 2019 (COVID-19) has increased, but the data regarding its safety, efficacy, and mortality benefit remains unclear. The focus of our review is to further expand on these areas and outline the indication, techniques, and complications associated with its use.

Methods: We did an extensive search of various databases such as PubMed, Cochrane, ScienceDirect, and Jama Network and studied 41 papers, including free full articles such as systematic reviews, meta-analyses, and clinical trials published within the past five years.

Results: Implementation of ECMO is advantageous when the PaO2/FiO2 is in the range of 100 to 150 mmHg. For COVID-19 patients, the most appropriate approach is to drain from a femoral venous cannula and thread it to the inferior vena cava just 1-2cm below the cavoatrial junction.  It was seen that the most common complication of ECMO use is coagulopathy. Limb ischemia had a variable incidence from 10 to 70% and is more common in venous-arterial ECMO.

Conclusion: ECMO is lifesaving in a highly selected group of patients to prolong survival, reduce complications and provide a good prognosis in terms of mortality. To prevent circuit thrombosis, anticoagulation is key, and understanding feasible intra-atrial communication sites, such as a patent foramen ovale or atrial septal defects, is beneficial to mitigate the risk of stroke and cutting down consequences of thromboembolism.