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The COVID-19 pandemic generated an unprecedented need for critical care resources including cost- and resource-intensive veno-venous extracorporeal membrane oxygenation (VV-ECMO). Through discussion of relevant ethical principles and challenges pertaining to VV-ECMO use, this article provides an overview of VV-ECMO resource allocation.
While noting significant regional and institutional variation in resource availability and triage, the authors recommend adaptation of the Extracorporeal Life Support Organization guidelines, including use of the Respiratory Extracorporeal Membrane Oxygen Survival Prediction score, for patients being considered for VV-ECMO. Additionally, they emphasize the importance of earlier discussion of goals and expectations, especially around complications, with patients who may be candidates for invasive supportive therapies.
– Emmett A. Kistler, MD
This abstract is available on the publisher's site.
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.