COVID-19 related cardiopulmonary failure such as ARDS and cardiogenic shock or massive pulmonary embolism can be successfully supported with ECMO. Judicious patient selection is important to enable maximal benefit and optimized outcomes with this limited resource during a pandemic.

The possibility of discontinuing ECMO for futility should be discussed with the family prior to cannulation.

The absence of hope for healthy survival should be considered as an indication for withdrawing ECMO, and is demonstrated by severe brain damage, severe irreversible multi-organ failure, or absence of heart or lung recovery without a durable option for replacement (ventricular assist device or transplant).

The optimal timing for determining absence of recovery will vary by center, but no cardiac function for 3-5 days on V-A ECMO would meet the definition of futility in many ECMO centers.

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