Key Recommendations
V-V ECMO may be utilized for patients with COVID-19 and severe respiratory failure with expected outcomes comparable to patients supported with V-V ECMO prepandemic.
V-A ECMO may be utilized for patients with COVID-19 and severe cardiac failure; however, the experience is more limited.
Mobile ECMO is feasible and may be conducted safely for patients with COVID-19.
Organize ECMO centers within geographic regions to coordinate patient referrals, where feasible.
Unify patient selection criteria across a geographic region, where feasible.
Contraindications for ECMO use should become more stringent as ECMO capacity diminishes.
Data submission to facilitate research is essential for our evolving understanding of optimal ECMO care for patients with COVID-19.
While some centers have increased their anticoagulation targets, bleeding remains a concern, and there is no data to recommend deviation from conventional anticoagulation goals.
There is no data to recommend deviation from conventional ECMO practices, e.g., blood product transfusion thresholds, tracheostomy, endotracheal extubation, rehabilitation, cannulation configuration, or ventilator management.
Potential discontinuation of ECMO in the setting of perceived futility should be clearly discussed with patients and their surrogate decision-makers.
Rarely, children can require ECMO support for severe ARDS, myocarditis, or multisystem inflammatory disease in children; ECMO patient selection and management should follow conventional guidelines.