Venovenous extracorporeal membrane oxygenation in patients with COVID-19 respiratory failure

The high level of human-to-human transmissibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the severity of coronavirus disease 2019 (COVID-19) have perpetuated an international public health emergency. Indeed, this pandemic has evolved into the greatest health challenge of the 21st century. Virus entry is mediated by the structural spike membrane protein, which plays a significant role in host cell receptor recogni-tion and membrane fusion. Angiotensin-converting enzyme 2 serves as the functional culprit host cell receptor.1 The COVID-19 pandemic has tested the resilience of the global health infrastructure and unleashed a slew of novel stra-tegies and technological advances in the armamentarium against this viral threat. Like the experience with influenza pandemic of the early 2000s, extracorporeal support has served as a rescue option favored in the face of failing conventional therapy. The clinical experience with extracorporeal mem-brane oxygenation (ECMO) thus far has been framed through the lens of single-center, nonrandomized reports that vary in both methodology and outcomes.2-5 Severity of disease may be estimated using the World Health Organization classification system, which assigns a grade from 1 to 9 in order of increasing severity.6 There is not yet a consensus ECMO-specific scoring system, and to this end, the Murray, PRESERVE,4 and RESP5 scores each remain applicable in the quantification of severity in this cohort, although not neces-sarily specific to COVID-19 or its prognosis.