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World J Crit Care Med. Jan 9, 2021; 10(1): 1-11
Published online Jan 9, 2021. doi: 10.5492/wjccm.v10.i1.1
Utilization of extracorporeal membrane oxygenation during the COVID-19 pandemic
Asim Kichloo, Akshay Kumar, Rawan Amir, Michael Aljadah, Najiha Farooqi, Michael Albosta, Jagmeet Singh, Shakeel Jamal, Zain El-Amir, Akif Kichloo, Nazir Lone
Asim Kichloo, Michael Albosta, Shakeel Jamal, Zain El-Amir, Department of Internal Medicine, Central Michigan University, Saginaw, MI 48603, United States
Akshay Kumar, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA 15260, United States
Rawan Amir, Department of Internal Medicine, University of Maryland, Baltimore, MD 20742, United States
Michael Aljadah, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Najiha Farooqi, Department of Surgery, Central Michigan University, Saginaw, MI 48603, United States
Jagmeet Singh, Department of Nephrology and Transplant Nephrology, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
Akif Kichloo, Department of Anesthesiology and Critical Care, Saraswathi Institute of Medical Sciences, Uttar Pradesh 245304, India
Nazir Lone, Department of Pulmonology and Critical Care, Northwell Health, Riverhead, NY 11901, United States
Author contributions: Kichloo A, Kumar A, Amir R, Farooqi N and Aljadah M are credited with substantial contribution to the design of the work, literature review of all the sections discussed, the revision of critically important intellectual content, final approval of the published version, and agreement of accountability for all aspects of the work; Albosta M, and El-Amir Z are credited with substantial acquisition, analysis, and extraction of the literature reviewed for the manuscript, drafting the manuscript, final approval of the version to be published, and agreement of accountability for all aspects of the work; Jamal S, Singh J, Kichloo A and Lone N are credited with the revision of critically important intellectual content and final approval of the version to be published, and agreement of accountability for all aspects of the work.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors who contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Michael Albosta, MD, Doctor, Department of Internal Medicine, Central Michigan University, 1632 Stone Street, Saginaw, MI 48603, United States. albos1ms@cmich.edu
Received: September 16, 2020
Peer-review started: September 16, 2020
First decision: December 1, 2020
Revised: December 7, 2020
Accepted: December 23, 2020
Article in press: December 23, 2020
Published online: January 9, 2021
Processing time: 111 Days and 12.4 Hours
Abstract

The ongoing outbreak of severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2, or coronavirus disease 2019 (COVID-19)] was declared a pandemic by the World Health Organization on March 11, 2020. Worldwide, more than 65 million people have been infected with this SARS-CoV-2 virus, and over 1.5 million people have died due to the viral illness. Although a tremendous amount of medical progress has been made since its inception, there continues to be ongoing research regarding the pathophysiology, treatments, and vaccines. While a vast majority of those infected develop only mild to moderate symptoms, about 5% of people have severe forms of infection resulting in respiratory failure, myocarditis, septic shock, or multi-organ failure. Despite maximal cardiopulmonary support and invasive mechanical ventilation, mortality remains high. Extracorporeal membrane oxygenation (ECMO) remains a valid treatment option when maximal conventional strategies fail. Utilization of ECMO in the pandemic is challenging from both resource allocation and ethical standpoints. This article reviews the rationale behind its use, current status of utilization, and future considerations for ECMO in critically ill COVID-19 patients.

Keywords: Extracorporeal membrane oxygenation, COVID-19, Critical care, Acute respiratory distress syndrome, Shock, Research

Core Tip: This article aims to provide a review of the rationale for the use of extracorporeal membrane oxygenation (ECMO) in patients suffering from severe coronavirus disease 2019 (COVID-19) infection, including a discussion of current utilization practices, and ends with important future considerations for ECMO in critically ill COVID-19 patients as we progress during the current pandemic.