Lean Ad-hoc Extracorporeal Membrane Oxygenation Systems for COVID-19.

Hunziker, Patrick; Zenklusen, Urs

COVID-19 is overwhelming hospitals with patients requiring respiratory support, including ventilators and ECMO. Bottlenecks in device availability may contribute to mortality, and limited device availability even in ECMO centers has led to rationing recommendations. Therefore, we explored options for ad-hoc construction of veno-venous ECMO using readily available components, essentially, large cannulas, membrane oxygenators, and blood pumps. As thousands certified cardiac Impella pumps are distributed worldwide, we assembled lean ECMO by embedding Impella pumps coaxially in tubes, combined with standard gas exchangers.Ad-hoc integration of Impella blood pumps with gas exchange modules, large-bore venous cannulas, regular ECMO tubing, Y-pieces and connectors led to lean ECMO systems with stable performance over several days. Oxygenation of 2.5-5 L of blood/minute is realistic. Benefit/risk analysis appears favorable if a patient needs respiratory support but required support systems in a center are exhausted.Ad-hoc assembly of veno-venous ECMOs is feasible using Impella blood pumps, results in stable blood flow across gas exchange modules, and thus may offer another opportunity to oxygenate, "recover the lungs" and hopefully save lives in selected patients with severe COVID-19 disease even when conventional life support equipment is exhausted. The lean design also yields inspirations for future ECMO systems.