Health systems confronting the coronavirus disease 2019 (COVID-19) pandemic must plan for surges in ICU demand and equitably distribute resources to maximize benefit for critically ill patients and the public during periods of resource scarcity. For example, morbidity and mortality could be mitigated by a proactive regional plan for the triage of mechanical ventilators. Extracorporeal membrane oxygenation (ECMO), a resource-intensive and potentially life-saving modality in severe respiratory failure, has generally not been included in proactive disaster preparedness until recently. This paper explores underlying assumptions and triage principles that could guide the integration of ECMO resources into existing disaster planning. Drawing from a collaborative framework developed by one US metropolitan area with multiple adult and pediatric extracorporeal life support centers, this paper aims to inform decision-making around ECMO use during a pandemic such as COVID-19. It also addresses the ethical and practical aspects of not continuing to offer ECMO during a disaster.
Bibliographical noteFunding Information:
Financial/nonfinancial disclosures: None declared. Other contributions: We thank Joel T. Wu, JD, MPH, with the Center for Bioethics, University of Minnesota Medical School, for expert review of e-Appendix 1. We also thank the Minnesota Department of Health Science Advisory Team and the representatives from the ECMO centers in our state for their ongoing commitment to patient and community service. Additional information: The e-Appendix can be found in the Supplemental Materials section of the online article.
© 2020 American College of Chest Physicians
- ECMO (extracorporeal membrane oxygenation)
- critical care