Introduction

The use of extracorporeal membrane oxygenation (ECMO) in the management of severe acute respiratory distress syndrome (ARDS) has been well established in recent years1, 2, 3, 4 but the ongoing coronavirus disease 2019 (COVID-19) pandemic has presented new limitations in knowledge and has complicated the implementation of ECMO. Severe COVID-19 frequently presents with acute respiratory failure in the form of ARDS, and the pandemic has been characterized by surges in the volume of critically ill patients with ARDS worldwide.

Episodic surges in patients with COVID-19-related ARDS have been accompanied by strain both on health-care resources (eg, beds, staffing, medical supplies) and in the ability to provide equitable access to care, all of which is further exaggerated when considering the application of ECMO, a highly resource-intensive and specialized technology.

As the pandemic has evolved, the medical community has learned not only about the role of ECMO for COVID-19 from a clinical standpoint but also about how to gather knowledge in real-time about the use of ECMO for a novel disease, the limitations in our ability to equitably deliver health-care resources across the globe, and how to devise best strategies for care in light of substantial resource constraints. The use of ECMO for cardiac or circulatory failure, including for extracorporeal cardiopulmonary resuscitation, has been relatively limited in the setting of COVID-19; we will focus on the use of ECMO for respiratory failure.