ECMO Program Emergency Planning and Response to the COVID-19 Pandemic

Introduction: Coronavirus disease 2019 (COVID-19) remains a worldwide pandemic with some patients requiring escalation to venovenous extracorporeal membrane oxygenation (VV-ECMO) Our ECMO Program placed 30 adult COVID-19 patients on VV ECMO within six weeks This surge required immediate assessment of our program's current structure and resources and rapid execution of an emergency response plan Methods: Additional hardware and disposable supplies were acquired through capital purchases, rental agreements, collaboration with neighboring institutions, and repurposing of existing equipment All patients were ultimately cohorted to one location Our Perfusion team implemented a new staffing schedule to increase ECMO coverage A condensed COVID ECMO course was created to increase the number of ECMO-trained nurses Existing bedside cannulation carts and an exchange process with Central Supply allowed for multiple cannulations in various locations A daily report was distributed to ECMO and hospital leadership to promote effective communication and ensure transparency of ECMO capacity Results: As of August 20th, 27 patients survived to ECMO decannulation and 23 patients survived to hospital discharge Five patients remain hospitalized During the surge, we averaged 13 patients on ECMO per day, which was an increase over our baseline of 3 5 patients per day for the six months preceding COVID-19 Conclusion: We conclude that it is possible to safely expand ECMO capacity during a pandemic This requires proper planning and reallocation of resources as necessary Our navigation of the surge was aided by our existing program processes and the generosity of neighboring ECMO programs and our industry partners