ECMO Services During the COVID-19 Outbreak:
The actual number of patients with COVID-19 who might present with
severe acute respiratory distress syndrome (ARDS) refractory to maximum
medical treatment is unknown to a large extent. The WHO interim
guidelines (8) for the management of patients suspected of COVID-19
infection recommend administering ECMO when such patients present with
severe ARDS in expert centers with sufficient case volumes. Experience
as regards previous emerging infectious outbreaks is evidence that
further supports the efficacy of ECMO in the current evolving pandemic.
(9) ECMO services should be provided in well-equipped centers with
sufficient experience and dedicated multidisciplinary teams specially
trained for the management of patients requiring ECMO. There are no
published data on experience with ECMO in patients with COVID-19 in
Iran; be that as it may, Masih Daneshvari Medical and Research Center,
the main referral center in the COVID-19 pandemic, has invaluable
experiences in this regard. From March 1, 2020 to May 8, 2020, ECMO was
utilized for 7 patients by that center. Three of these patients were
weaned from ECMO successfully, but only 1 patient was discharged from
the hospital in a stable condition. The remaining 3 patients had clot
formation in the oxygenator, and it appears that a higher dose of
heparin should be administered to achieve an activated clotting time of
more than 250 seconds. Regrettably, only a few centers in Iran can
provide ECMO services; the majority of cardiovascular centers are devoid
of not only ECMO devices but also oxygenators and cannulae because large
pharmaceutical companies have been forced out of Iran’s market by the
economic sanctions imposed on the country.