This collaborative survey done by the Society of Thoracic Surgeons/Extracorporeal Life Support Organization highlights several key changes in ECMO utilization and practice in North America: programs performing >20 VV ECMO cases per year (high-volume centers) increased; the number of clinicians determining the eligibility of ECMO initiation increased; resource allocation and triage protocols for ECMO were developed for use within individual centers and for regional cooperation between centers; the demand for ECMO resulted in more hospitals having to care for ECMO patients in multiple units; and the use of direct thrombin inhibitors increased.

The increase in the proportion of high-volume VV ECMO programs reflects increased demand for ECMO for respiratory failure. As a result, high-volume centers may have reached their capacity limit, forcing low-volume ECMO centers to expand their capacity.

This increased demand changed ECMO practices during the pandemic, with a doubling of centers reporting that VV ECMO patients were cared for in multiple units.

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