Rationing runs deeper than ventilators & PPE. Some #COVID19 patients may receive extracorporeal membrane oxygenation (ECMO), or cardiopulmonary life support, as an adjunct to ventilation & medical mgmt. ECMO therapy can be life saving but it's hardly guaranteed (1)

ECMO is an advanced therapy option offered by 859 centers worldwide, with 304 in the U.S. alone (src: http://ELSO.org ). It requires a highly-skilled team of critical care specialists (MDs, perfusionists, RNs, RTs, etc). Successful outcomes depend heavily on experience (2)

Above staffing, this therapy is resource intensive. ECMO pumps are mini-cardiopulmonary bypass machines, siphoning blood outside the body, performing gas exchange (O2 delivery, CO2 removal), and pumping the blood back into the patient's circulation (3)

These machines ain't cheap. ECMO pumps run anywhere from $40K-110K+ for hardware alone. Tack on another $2K-13K+ for circuit disposable costs. Bear in mind, ECMO circuits need to get changed out every several days for fibrin deposits, clot formation, and loss of efficacy (4)

Not every #COVID19 ICU patient is a good candidate for ECMO. The ELSO consortium provides guidelines as to who qualifies (see algorithm attached). But with limited resources and competent staff, physicians are left having to ration pumps, effectively playing God with care (5)

Per ELSO guidelines, high-priority patients include younger ARDS patients with minimal comorbidities (at my center, #CV19 ECMO patients are all <45 y/o) and COVID-infected healthcare workers. Patients with multi-organ failure or >7 days on a ventilator may be excluded (6)

Under normal conditions, the use of ECMO for pulmonary distress has a survival rate of 60% (src: ELSO 2019 Registry). ECMO therapy in #COVID treatment is still in its infancy but we are learning more about its utility each day. Frontline workers, like me, are hopeful! (7)