The Southern California Extracorporeal Membrane Oxygenation Consortium During the Coronavirus Disease 2019 Pandemic

Abstract

In March 2020, at the onset of the coronavirus disease 2019 (COVID-19) pandemic in the United States, the Southern California Extracorporeal Membrane Oxygenation (ECMO) Consortium was formed. The consortium included physicians and coordinators from the four ECMO centers in San Diego County. Guidelines were created to ensure that ECMO was delivered equitably and in a resource effective manner across the county during the pandemic. A biomedical ethicist reviewed the guidelines to ensure ECMO utilization would provide maximal community benefit of this limited resource. The San Diego County Health and Human Services Agency further incorporated the guidelines into its plans for the allocation of scarce resources. The consortium held weekly video conferences to review countywide ECMO capacity (including census and staffing), share data, and discuss clinical practices and difficult cases. Equipment exchanges between ECMO centers maximized regional capacity. From March 1 to November 30, 2020, consortium participants placed 97 patients on ECMO. No eligible patients were denied ECMO due to lack of resources or capacity. The Southern California ECMO Consortium may serve as a model for other communities seeking to optimize ECMO resources during the current COVID-19 or future pandemics.

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“…care systems, severe phenotype of ARDS, and empiric anticoagulation, which was eventually found to be harmful. 3,12,13 Similar to our findings, the RESP score has been found by others to have a poorer prediction of survival with an area under the curve of 0.61 in COVID-19 patients. 14 Because of the longer ECMO duration in patients with COVID-19, risk of complications increased such as coagulopathies, strokes, intracranial hemorrhages, and ventilator-associated pneumonia.…”

“…2 Accordingly, access to ECMO is limited, requiring some regions to form ECMO consortiums to ensure equal and equitable access to ECMO. 3 Because of high cost and limited ECMO capacity, determining appropriate candidates for ECMO is imperative to ensure judicious use. This was particularly relevant during the coronavirus disease 2019 (COVID-19) pandemic where health care systems were stressed because of surges of critically ill patients combined with resource limitations such as equipment, beds, and staff.…”

Clinician Prediction of Survival vs Calculated Prediction Scores in Patients Requiring Extracorporeal Membrane Oxygenation

“…Coronavirus disease 2019 also has a more severe phenotype of ARDS relative to other viral pneumonias that require ECMO; the international COVID-19 survival on the Extracorporeal Life Support Organization database is 53% compared to 65% in the ECMO to Rescue Lung Injury in Severe ARDS trial 10,11 . Patients with COVID-19 may have had higher mortality due to overwhelmed health care systems, severe phenotype of ARDS, and empiric anticoagulation, which was eventually found to be harmful 3,12,13 . Similar to our findings, the RESP score has been found by others to have a poorer prediction of survival with an area under the curve of 0.61 in COVID-19 patients 14 .…”

“…In-hospital costs are approximately $100 000 per patient; however, these costs range from $42 554 to $537 554 in the United States 2 . Accordingly, access to ECMO is limited, requiring some regions to form ECMO consortiums to ensure equal and equitable access to ECMO 3 . Because of high cost and limited ECMO capacity, determining appropriate candidates for ECMO is imperative to ensure judicious use.…”