The authors reply.

We would like to thank Crowley et al (1) for their interest in our editorial (2), recently published in Critical Care Medicine, on adult extracorporeal membrane oxygenation (ECMO) patient selection. In their letter to the editor, Crowley et al (1) discussed the merits of establishing a formal review panel for the allocation of resources during the current coronavirus disease 2019 pandemic, particularly in regions experiencing high case volumes and strains on hospital resources. The authors highlighted key aspects of ECMO patient selection in a pandemic state where circuit availability is scarce, such as optimal device selection to enable hybrid configurations to support multiple organ systems (heart, lungs, and kidneys).

We agree that, when possible, an ECMO review panel or triage officer not directly involved in current patient care should be used for resource allocation decisions. The rationale for an unbiased yet clinically informed triage committee or triage officer was also recently outlined by Sprung et al (3). If possible, the burden of patient prioritization and deprioritization of ECMO candidates and reallocation of ECMO resources should be removed from the clinician directly caring for the patients, and instead handled by a preplanned review panel and/or triage officer. We believe the review panel or triage officer must possess in-depth knowledge of ECMO in order to most effectively function in this role. Under crisis conditions, ECMO experts may not be available to serve on a review panel or as a triage officer. However, if an ECMO center has a sufficient number of clinicians with ECMO expertise, then we agree with Crowley et al (1) and Sprung et al (3) that an ECMO review panel with ECMO expertise should be established. The authors’ description of real-time cross-disciplinary consultation via group chat and videoconferencing is an excellent illustration of how this may be accomplished in the context of social distancing.