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This Concise Critical Appraisal explores a Lancet Respiratory Medicine article by Ramanathan et al, which outlines how to plan for extracorporeal membrane oxygenation (ECMO) for patients with severe acute respiratory distress syndrome (ARDS) related to COVID-19. ECMO is a complex therapy usually restricted to specialized centers. World Health Organization guidelines suggest that carefully selected patients with ARDS may benefit. The authors explore how good planning can help during outbreaks of emerging infectious diseases.
Our understanding of COVID-19 pneumonia is constantly evolving as deliberations continue daily regarding the risks, benefits, and timing of mechanical ventilation and various medication trials. The lungs of many patients with COVID-19 start with normal compliance and worsen to a high elastance/low compliance state that is consistent with acute respiratory distress syndrome (ARDS) (Gattinoni et al. Intensive Care Med. 2020 [Epub ahead of print]). World Health Organization interim guidelines recommend extracorporeal membrane oxygenation (ECMO) for eligible patients with severe ARDS related to COVID-19. Evidence from similar patient populations suggests that carefully selected patients with severe ARDS who do not benefit from conventional treatment might be successfully supported with venovenous ECMO. Ramanathan et al (Lancet Respir Med. 2020;8:518-526) outline how to plan for this complex therapy that is usually restricted to specialized centers and how this planning can help during other outbreaks of emerging infectious diseases.
The H1N1 pandemic was transformational for the ECMO community. The surge of patients resulted in a steady increase of ECMO-capable centers and the creation of strategic disaster planning. Aftermath research revealed promise for ECMO, with many success stories, despite evidence that mortality rates were difficult to determine because of many confounding factors, mainly the treatment course leading up to cannulation (Zangrillo et al. Crit Care. 2013;17:R30).
Infrastructure and resources to provide this lifesaving therapy have expanded rapidly over the past decade. Venovenous ECMO has quickly become a vital component of the management of severe refractory respiratory failure in ARDS. Ramanathan et al discuss a framework for building a sustainable system for patient management during global pandemics and times of increased resource use. They discuss how ECMO surge planning can be categorized into ensuring appropriate organization of four key components: personnel, equipment, facilities, and systems. They then discuss 10 key components of an ECMO action plan based on these four categories:
Posted: 5/13/2020 | 0 comments
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