Table 1.
Contraindications for VV‐ECMO in COVID‐19
| Standard contraindications |
| Age > 70 y.o. |
| Body mass index > 45 with a high risk of vascular accessa |
| Mechanical ventilation > 7 days |
| Multiorgan failure |
| End‐stage liver disease |
| Irreversible neurological damage |
| Contraindications of anticoagulation |
| Ventricular dysfunction |
| Severe vasoplegia requiring high dose of vasopressor |
| Cardiac arrest without ROSC |
| Relative contraindications |
| Age > 65 y.o. |
| Body mass index > 35 |
| Mechanical ventilation > 5 days |
| Active bacterial bloodstream infection |
| Severe COPD |
| Cirrhosis |
| Chronic heart failure |
| Inability of access neuro status |
| High lactate related to low perfusion status |
| Limited activity at home |
| No family or appropriate power of attorney |
| Mobile ECMO for outside of networkb |
Abbreviations: COPD, chronic obstructive pulmonary disease; COVID‐19, coronavirus disease 2019; ECMO, extracorporeal membrane oxygenation; ROSC, return of spontaneous circulation; VV‐ECMO, veno‐venous‐ECMO.
In the influenza group, we may offer VV‐ECMO in a morbidly obese patient via the right internal jugular vein using Avalon cannula as long as the patient's neck anatomy is feasible for cannulation; however, in the COVID‐19 group, we no longer offer VV‐ECMO in morbidly obese patients since we typically do not use the Avalon cannula in COVID‐19 patients.
We did not offer mobile ECMO (when our ECMO team travels to outside hospitals to initiate cannulation and transport the patient back to our institution on ECMO) in outside‐of‐network hospitals for COVID‐19 patients, while we could offer this to influenza patients.