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

Mazen Odish,Juliann Eigner,Cassia Yi,Scott Mccaul,Ayana Boyd King,Kristi L Koenig,Amelia Kenner Brininger,Travis Pollema,Robert L Owens,David Willms,Suzan Lerum,George Sutherland,Lynette Cederquist

doi:10.1017/dmp.2021.179

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 4 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 use 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.

Highlights

Health Organization guidelines recommend transfer to an Extracorporeal Membrane Oxygenation (ECMO) center for COVID-19 patients with severe ARDS that is refractory to conventional therapies, but this may not always be possible due to patient instability or resource limitations.[7]
After the ECMO Consortium guidelines were developed, they were distributed to the regional hospitals and the San Diego County Health & Human Services Agency
From June 19 to November 27, 2020, the consortium was in contingency and crisis phase 79% and 21% of the time, respectively (Figure 2)

Summary

Introduction

Health Organization guidelines recommend transfer to an ECMO center for COVID-19 patients with severe ARDS that is refractory to conventional therapies, but this may not always be possible due to patient instability or resource limitations.[7]. In the setting of a pandemic, allocation of scarce resources, such as ECMO, must shift from prioritization of the good of the individual to the good of the community when crisis standard of care is declared.[1,8] The ethical guiding principles in this setting include the prioritization of the most lives saved, equity, transparency, and duty to plan. Only 3 centers in the county are able to provide management and comprehensive care for adult patients on ECMO

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Conclusion