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.