As US Covid-19 confirmed cases continues to surge, are ECMO facilities prepared?

GlobalData Healthcare 25 March 2020 (Last Updated March 25th, 2020 16:08)

As US Covid-19 confirmed cases continues to surge, are ECMO facilities prepared?

As the number of Covid-19 cases in the US continues to surge at 41% each day, GlobalData estimates that up to 12,000 patients may require extracorporeal machine oxygenation (ECMO).

Over the past few weeks, the number of Covid-19 cases in the US has been growing exponentially, increasing at an average of 41% per day since 16 March to more than 44,000 cases today. With the shortage of ventilators and surging number of cases, it is only a matter of time before there is an increased need for ECMO to ensure the survival of critically ill patients.

ECMO is a specialised form of life support, supplementing oxygen to the blood and removing carbon dioxide. The World Health Organization’s (WHO’s) guidance document for the clinical management of severe acute respiratory infection from Covid-19 recommends the use of ECMO for acute respiratory distress syndrome (ARDS) patients when all other lung-protective ventilation strategies fail. However, in the US there is currently hesitation surrounding the promotion of ECMO, largely attributed to the finite resources available and the complex nature of the treatment.

As of 2019, there were 261 facilities in North America registered with ELSO. The image projects the number of patients who may require ECMO over a two-week period based on the projections of confirmed cases. GlobalData estimates that the number of critical cases currently requiring ECMO is just shy of 50 cases. In the low-risk scenario, only 255 cases will require ECMO. However, given the continuous rise in cases over the past week and delayed efforts in applying nationwide mitigation strategies, the caseload could reach close to 12,000 cases by early April, and in a high-risk scenario, could reach up to 32,000 critical patients.

ECMO machines have proven to be successful in several countries outside of the US, such as China, South Korea, and Japan. The decision to use ECMO still depends on a number of factors, including the patient’s condition and the likelihood of survival, and not all patients requiring life support may be eligible for the treatment. While the body of the available evidence is still small, failure to mitigate the continuous exponential increase of cases and hence an increase in critical cases that can survive with life support will likely push more physicians to utilise ECMO.

In the event that the need for ECMO far surpasses the available resources, this shortage will be significantly more challenging to mitigate than the ventilator shortage. In addition to the shortage of equipment and not being able to reserve all machines for only Covid-19 patients, ECMO programs also require a team of highly trained professionals that are able to operate the equipment and be on-call for 24 hours, both of which are resources that the current healthcare system will not be able to provide.