Perspectives

Ethical Dilemma ECMO and COVID

Authors: Paul Eckerle, MD, Aniruddh Kapoor, MD, Setu Patolia, MD, MPH

Abstract

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic >5.5 million deaths have been reported;1 however, the magnitude of its impact is much greater and runs far deeper. The unmeasurable effect on the global economy, the social implications, and the stress placed on an already fractured healthcare system have changed humanity forever.  In the intensive care unit (ICU), where many COVID-19 patients are treated for respiratory failure caused by acute respiratory distress syndrome (ARDS), we have only a few targeted therapies with minimal efficacy. Supportive care often is the best of what we can provide. These supportive therapies aim to maintain homeostasis as the disease runs its course. One extreme example is extracorporeal membrane oxygenation (ECMO). It is an extremely invasive therapy that diverts most of a patient’s circulating volume through an external membrane that oxygenates the blood and removes carbon dioxide. Although lifesaving, ECMO does not combat COVID-19 directly. It merely buys time while the body and the lungs recover.
Posted in: Infectious Disease143

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References

1. World Health Organization. WHO coronavirus (COVID-19) dashboard. https://covid19.who.int. Accessed January 15, 2022.
 
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3. Peek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 2009;374:1351–1363.