Efficacy of multidisciplinary team approach with extracorporeal membrane oxygenation for COVID-19 in a low volume ECMO center

Artif Organs. 2021 Sep;45(9):1061-1067. doi: 10.1111/aor.13947. Epub 2021 Apr 16.


Veno-venous extracorporeal membrane oxygenation (VV ECMO) is an effective and proven adjunct support for various severe respiratory failures requiring invasive mechanical ventilation and cardiovascular support. In response to the rapidly increasing number of COVID-19 patients in Japan, we launched an ECMO support team comprised of multidisciplinary experts including physicians, nurses, perfusionists, and bioethicists in preparation for the threat of a pandemic. From April 2 to July 15, 2020, Tokyo Medical and Dental University hospital treated 104 PCR confirmed COVID-19 patients. Among those, 34 patients were admitted to intensive care unit (ICU) and 5 patients required VV ECMO. All management related to ECMO was decided by the ECMO support team in addition to participation of the ECMO support team in daily multidisciplinary rounds in the ICU. Median age was 54 years old. Duration from onset to mechanical ventilation (MV) and MV to ECMO were 8 and 7 days, respectively. Four patients (80%) were successfully weaned off from ECMO. One patient died after 81 days of ECMO run. Four patients were discharged and recovered to their prehospital quality of life without major disability. We achieved a high survival rate using ECMO in our low volume ECMO institution during the COVID-19 pandemic. Multidisciplinary decision-making and a team approach for the unclear pathology with an emerging infectious disease was effective and contributed to the survival rate.

Keywords: acute respiratory distress syndrome; coronavirus disease 2019; team approach; veno-venous extracorporeal membrane oxygenation.

MeSH terms

  • Adult
  • Aged
  • COVID-19 / diagnosis
  • COVID-19 / mortality
  • COVID-19 / physiopathology
  • COVID-19 / therapy*
  • Cooperative Behavior
  • Extracorporeal Membrane Oxygenation* / adverse effects
  • Extracorporeal Membrane Oxygenation* / mortality
  • Female
  • Hospital Mortality
  • Hospitals, Low-Volume*
  • Humans
  • Interdisciplinary Communication
  • Male
  • Middle Aged
  • Patient Care Team*
  • Recovery of Function
  • Respiration, Artificial
  • Retrospective Studies
  • Time Factors
  • Time-to-Treatment
  • Tokyo
  • Treatment Outcome