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Preparing for the Most Critically Ill Patients With COVID-19The Potential Role of Extracorporeal Membrane Oxygenation

Educational Objective
Understand the importance of extracoporeal membrance oxygenation (ECMO) for the most vulnerable patients in combating COVID-19
1 Credit CME

The novel coronavirus has now infected tens of thousands of people in China and has spread rapidly around the globe.1 The World Health Organization (WHO) has declared the disease, coronavirus disease 2019 (COVID-19), a Public Health Emergency of International Concern and released interim guidelines on patient management.2 Early reports that emerged from Wuhan, the epicenter of the outbreak, demonstrated that the clinical manifestations of infection were fever, cough, and dyspnea, with radiological evidence of viral pneumonia.3,4 Approximately 15% to 30% of these patients developed acute respiratory distress syndrome (ARDS). The WHO interim guidelines made general recommendations for treatment of ARDS in this setting, including that consideration be given to referring patients with refractory hypoxemia to expert centers capable of providing extracorporeal membrane oxygenation (ECMO).2

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Article Information

Corresponding Author: Graeme MacLaren, MSc, Cardiothoracic Intensive Care Unit, National University Health System, 5 Lower Kent Ridge Rd, Singapore 119074 (gmaclaren@iinet.net.au).

Published Online: February 19, 2020. doi:10.1001/jama.2020.2342

Conflict of Interest Disclosures: Dr Brodie reported receiving grants from Alung Technologies, serving on the medical advisory board for Alung Technologies, Xenios, Breethe, Baxter, and Hemovent. No other disclosures were reported.

References
1.
Paules  CI , Marston  HD , Fauci  AS .  Coronavirus infections—more than just the common cold.   JAMA. 2020. Published online January 23, 2020. doi:10.1001/jama.2020.0757PubMedGoogle Scholar
2.
World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected—interim guidance. Published January 28, 2020. Accessed February 11, 2020. https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected
3.
Wang  D , Hu  B , Hu  C ,  et al.  Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.   JAMA. Published online February 7, 2020. doi:10.1001/jama.2020.1585Google Scholar
4.
Chen  N , Zhou  M , Dong  X ,  et al.  Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study.   Lancet. Published online January 30, 2020. doi:10.1016/S0140-6736(20)30211-7Google Scholar
5.
Brodie  D , Slutsky  AS , Combes  A .  Extracorporeal life support for adults with respiratory failure and related indications: a review.   JAMA. 2019;322(6):557-568. doi:10.1001/jama.2019.9302PubMedGoogle ScholarCrossref
6.
Goligher  EC , Tomlinson  G , Hajage  D ,  et al.  Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome and posterior probability of mortality benefit in a post hoc bayesian analysis of a randomized clinical trial.   JAMA. 2018;320(21):2251-2259. doi:10.1001/jama.2018.14276PubMedGoogle ScholarCrossref
7.
Barbaro  RP , Odetola  FO , Kidwell  KM ,  et al.  Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry.   Am J Respir Crit Care Med. 2015;191(8):894-901. doi:10.1164/rccm.201409-1634OCPubMedGoogle ScholarCrossref
8.
White  DB , Angus  DC .  Preparing for the sickest patients with 2009 influenza A(H1N1).   JAMA. 2009;302(17):1905-1906. doi:10.1001/jama.2009.1539PubMedGoogle ScholarCrossref
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