Conclusions
Our experience shows that adequate planning of veno-venous ECMO
cannulation allows safe completion of the procedure at bedside. This
strategy can be particularly useful in patients with refractory
hypoxemia due to COVID-19 associated severe ARDS as bedside cannulation
can minimize the inadvertent nosocomial transmission of this highly
contagious disease. Veno-venous ECMO management is resource-intensive
and limited to specialized referral centers but can be used as salvage
therapy in patients with refractory respiratory failure who have
preserved life-expectancy and few associated end-organ failures.
Certainly, we acknowledge the ethical dilemma of patient selection for
access to life-sustaining extracorporeal support during this pandemic.
Nonetheless, the opportunity of saving even a relatively small number of
patients in comparison to the large loss of lives produced by this
highly lethal disease cannot be ignored.