Prognosis when Using Extracorporeal Membrane Oxygenation (ECMO) for Critically Ill COVID-19 Patients in China: a Retrospective Case Series

The World Health Organization (WHO) has characterized the disease, coronavirus disease 2019 (COVID-19), as a pandemic on March 11, 2020 (www.who.int). As of March 11, the WHO had recorded a total of 118,326 confirmed COVID-19 cases, with 4292 death cases (www.who.int). While the cumulative mortality of COVID-19 is 3.63%, COVID-19 has resulted in more death cases than SARS and MERS combined. Within China, a total of 80,955 cases are confirmed, with 4257 severe cases in mainland China (www.nhc.gov.cn). In severe cases of COVID-19, patients experience rapid disease progression and can quickly progress to acute respiratory distress syndrome (ARDS).

Based on this, when COVD-19 patients develop ARDS and mechanical ventilation cannot be improved, extracorporeal membrane oxygenation (ECMO) can be used. As mortality rates among critically ill COVID-19 patients can be as high as 61.5%, ECMO may play a role in reducing mortality rates. The indications of using ECMO are “For patients with severe ARDS, it is recommended to perform lung expansion. In the case of adequate human resources, prone positioning should be recommended for at least 12 hours per day for protective ventilation. If severe respiratory failure persisted, then ECMO should be started as soon as possible.”

As anticipated, COVID-19 is a pandemic; all healthcare resources are stretched so that ECMO is not a therapy to be rushed to the frontline. Therefore, interim treatment guidelines of recommending ECMO for critically ill COVID-19 patients should be taken cautiously.