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
ECMO is a form of modified cardiopulmonary bypass in which venous blood is removed from the body and pumped through an artificial membrane lung in patients who have refractory respiratory or cardiac failure.5 Oxygen is added, carbon dioxide is removed, and blood is returned to the patient, either via another vein to provide respiratory support or a major artery to provide circulatory support. ECMO is a resource-intensive, highly specialized, and expensive form of life support with the potential for significant complications, in particular hemorrhage and nosocomial infection. Recent evidence suggests that use of ECMO in the most severe cases of ARDS is associated with reduced mortality.6 There is some evidence that outcomes from ECMO are better in higher-volume centers.7
Author：Graeme MacLaren, Dale Fisher, MBBS, Daniel Brodie, et al.