Possibilities and Considerations on the Use of ECMO as a Therapeutic Option for Patients with Acute Respiratory Distress Syndrome due to Viral Infections


Extracorporeal Membrane Oxygenation
Extracorporeal Life Support
Acute Respiratory Distress Syndrome
Viral Outbreak


How to Cite

Bakkali A, El Yacoubi H, Al Idrissi N, Sayah R, Laaroussi M. Possibilities and Considerations on the Use of ECMO as a Therapeutic Option for Patients with Acute Respiratory Distress Syndrome due to Viral Infections. Integr J Med Sci [Internet]. 2021 May 3 [cited 2024 Jun. 15];8. Available from: https://mbmj.org/index.php/ijms/article/view/445


Management of acute respiratory distress syndrome due to viral outbreak includes lower tidal volumes, lower inspiratory pressure, prone ventilation and conservative fluid management. Extracorporeal membrane oxygenation (ECMO) has been proposed as rescue therapy in critically ill patients.
However, in the absence of larger studies, the role of ECMO in reducing patient mortality rates remains unclear, since studies that reported such effect, both during the current as well as during previous outbreaks, were based on small sample sizes and their results are inconsistent. Furthermore, the use of ECMO might even be contraindicated in the presence of some conditions. Recurring to it has therefore to be discussed by qualified multi-disciplinary teams and based on a case by case strategy.



Paules CI, Marston HD, Fauci AS. Coronavirus infections-more than just the common cold. JAMA.2020;323(8):707-708. https://doi.org/10.1001/jama.2020.0757

Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-943. https://doi.org/10.1001/jamainternmed.2020.0994

Mac Laren C, Fisher D, Brodie D. Preparing for the most critically ill patients with COVID-19, the potential role of extracorporeal membrane oxygenation. JAMA. 2020;323(13): 1245-1246. https://doi.org/10.1001/jama.2020.2342

Pravda NS, Pravda MS, Koronowski R, Orvin K. Extracorporeal membrane oxygenation therapy in the COVID‐19 pandemic. Future Cardiol. 2020. https://doi.org/10.2217/fca‐2020‐0040

World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (2019‐nCoV) infection is suspected: interim guidance 2020. WHO/2019‐nCoV/clinical/2020;4. [Accessed 2021 Feb 04]. Available from: https://apps.who.int/iris/handle/10665/330893

Combes A, Hajage D, Capellier G, Demoule A, Lavoué S, Guervilly C, et al. Extracorporeal mem¬brane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018; 378(21): 1965–1975. https://doi.org/10.1056/nejmoa1800385

Sameed M, Meng Z, Marciniak ET. EOLIA trial: the future of extracorporeal membrane oxygenation in acute respiratory distress syndrome therapy? Breathe. 2019; 15: 244–246. https://dx.doi.org/10.1183%2F20734735.0363-2018

Kulkarni T, Sharma NS, Diaz-Guzman E. Extracorporeal membrane oxygenation in adults: A practical guide for internists. Cleve Clin J Med. 2016; 83: 373–384. https://doi.org/10.3949/ccjm.83a.15021

Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): A multicentre randomized controlled trial. Lancet. 2009; 374:1351–63. https://doi.org/10.1016/s0140-6736(09)61069-2

Sidebotham D. Extracorporeal membrane oxygenation-understanding the evidence: CESAR and beyond. J Extra Corpor Technol. 2011; 43(1): 23–26.

Holzgraefe B, Broomé M, Kalzèn H, Konrad D, Palm-r K, Frenckner B. Extracorporeal Membrane Oxygenation for Pandemic H1N1 2009 Respiratory Failure. Minerva Anestesiol. 2010 Dec; 76(12):1043-51.

Pham T, Combes A, Rozé H, Chevret S, Mercat A, Roch A, et al. Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis. Am J Respir Crit Care Med. 2013; 187(3): 276–285.

Noah MA, Peek GJ, Finney SJ, Griffiths MJ, Harrison DA, Grieve R, et al. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). JAMA. 2011; 306(15):1659‐1668. https://doi.org/10.1001/jama.2011.1471

Shinhiro T, Toru K, Satoshi N, Shingo I, Toshiyuki A, Ryoichi O, et al. Extracorporeal Membrane Oxygenation for 2009 Influenza A (H1N1) Severe Respiratory Failure in Japan. J Anesth. 2012; 26(5):650-7. https://doi.org/10.1007/s00540-012-1402-x

Alshahrani MS, Sindi A, Alshamsi F, El Tahan M, Alahmadi B, et al. Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. Ann Intensive Care.2018; 8(1):3. https://doi.org/10.1186/s13613-017-0350-x

World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected—interim guidance. Published January 28, 2020.

Extracorporeal life support organization COVID‐19 interim guidelines. [Accessed 2021 Feb 04]. Available from: https://www.elso.org/COVID19.aspx

Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of criti-cally ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020; 8(5): 475-81. https://doi.org/10.1016/s2213-2600(20)30079-5

Zeng Y, Cai Z, Xianyu Y, Yang BX, Song T, Yan Q. Prognosis when using extracorporeal membrane oxygenation (ECMO) for critically ill COVID-19 patients in China: aretrospective case series. Critical Care. 2020; 24: 148. https://dx.doi.org/10.1186%2Fs13054-020-2840-8

Henry BM, Lippi G. Poor survival with extracorporeal membrane oxygenation in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID‐19): pooled analysis of early reports. J Crit Care. 2020; 58:27‐28. https://doi.org/10.1016/j.jcrc.2020.03.011

Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020; 191: 145-147. https://doi.org/10.1016/j.thromres.2020.04.013

Chang JC. Acute respiratory distress syndrome as an organ phenotype of vascular microthrombotic disease: Based on hemostatic theory and endothelial molecular pathogenesis. Clin Appl Thromb Hemost. 2109; 25: 1076029619887437. https://doi.org/10.1177/1076029619887437

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