*The Role of VV-ECMO in Severe COVID-19 ARDS DOI: http://dx.doi.org/10.5772/intechopen.107047*


*Adapted from Badulak et al. [1], Dalia et al. [34], Camporota et al. [41], Karagiannidis et al. [40], and Herrmann et al. [44].*

#### **Table 2.**

*Selection criteria for VV ECMO in severe refractory COVID-19—A graduated approach.*

ECMO support. Most participants stated that their criteria for starting ECMO had changed during the COVID-19 pandemic, with lower age limits, decreased ECMO machine availability, and stricter inclusion criteria. Interestingly, the majority of

those surveyed agreed that it would be ethical to give extra priority to a healthcare worker who had contracted COVID-19 due to occupational exposure. Decision making pertaining to futility and cessation of therapy were predominantly guided by lack of benefit to the patient being supported, however, as the pandemic progressed, there was an increased move to a more utilitarian approach i.e., they would consider discontinuing ECMO in a patient with poor prognostic outcome, in order to provide ECMO to a patient more likely to survive [46]. The current ELSO guidance suggests that treatment may be regarded as futile and discontinued after 21 days. However, it is clear from the published data that COVID patients frequently require more prolonged ECMO support compared with other cohorts of up to 5 weeks duration [3, 47].

The process of patient selection is complex and multifactorial and for this reason optimal indications for ECMO support in patients with severe COVID-19 ARDS remain unknown. It is clear however that the indications for ECMO are moving away from rescue therapy and more into an extended form of standard conventional therapy.
