Utilization of extracorporeal membrane oxygenation during the COVID-19 pandemic

Figure 1 Pathophysiology of coronavirus disease 2019 infection. Viral binding and invasion of angiotensin converting enzyme 2 receptor-rich cells triggers destruction of infected cells with release of cytokines (mainly interleukin-6, interleukin-8 and tumor necrosis factor) and chemo-attractants, as well as activation of neighboring antigen presenting cells (APCs). Cytokine surge and APC activation triggers a T-cell mediated response and further release of cytokines. Activation of T-cells along with ongoing destruction of infected cells leads to cytokine storm. Symptoms developed range from mild respiratory symptoms to multiorgan failure and death based upon host response. ACE-2: Angiotensin converting enzyme 2; APCs: Antigen presenting cells; IL: Interleukin; TNF: Tumor necrosis factor; ARDS: Acute respiratory distress syndrome.