Consenso ECMO colombiano para paciente con falla respiratoria grave asociada a COVID-19

BACKGROUND AND OBJECTIVES: The COVID-19 epidemic has created an unprecedented challenge in the health system, generating increasing demand. About 5% of diagnosed patients require intensive care admissions, primarily for support with mechanical ventilation for a moderate to severe Acute Respiratory Distress Syndrome (ARDS). The reported mortalities can be very high. The two main causes of death in this type of infection are refractory hypoxaemia associated with ARDS and, shock with multiple organ failure. Extracorporeal Membrane Oxygenation (ECMO) has been used in patients with refractory hypoxaemia and without response to the management with protective mechanical ventilation, prone ventilation, and muscle relaxation. The World Health Organisation recommends considering ECMO in adult and paediatric patients with COVID-19 and severe refractory ARDS, if an expert team is available. METHODS: The formal consensus methodology was used to generate the ECMO Consensus in the SARS-CoV-2 infection with the best available evidence. The development of the consensus combined the techniques of selection, synthesis, evaluation, and grading of the evidence: formulation of the PICO question [P - Patient, Problem or Population. I - Intervention. C - Comparison, control or comparator. O - Outcome(s) (e.g. pain, fatigue, nausea, infections, death)] question, systematic search strategies, synthesis techniques (meta-analysis). The evaluation of the quality of the evidence and the grading of the strength of the recommendations was carried out using the GRADE strategy. RESULTS: The Colombian ECMO consensus for patients with severe respiratory failure associated with COVID-19 provides a summary of the evidence for the use of extracorporeal oxygenation membranes in severe hypoxemic respiratory failure associated with this SARS CoV-2 infection, giving recommendations on its indications, contraindications, considerations, and the implementation of the ECMOred Colombia group. CONCLUSIONS: The Colombian ECMO consensus is a consultation and guide document for the management of patients with refractory severe acute respiratory failure and cardiovascular dysfunction associated with COVID-19 candidates for ECMO.