ECMO

Extracorporeal membrane oxygenation (ECMO) is a life-support technique that takes over the function of the lungs, the heart, or both in patients with severe cardiorespiratory failure. Blood is drawn out of the body, passed through a membrane oxygenator that removes carbon dioxide and adds oxygen, and returned to the circulation — bypassing the failed organ for days or weeks while it recovers or until a definitive intervention is possible. ECMO is used in cases of severe respiratory failure (veno-venous ECMO, or VV-ECMO) and combined cardiac and respiratory failure (veno-arterial ECMO, VA-ECMO). Survival benefit is time-sensitive: earlier cannulation improves outcomes; delayed initiation once multi-organ failure has set in reduces the benefit sharply.

ECMO capacity is highly concentrated. Specialist ECMO centres exist primarily at major academic and tertiary referral hospitals. The United States has approximately 250 ECMO-capable centres, but less than half run programmes of sufficient volume to maintain proficiency for complex cases. Transport of an unstable patient to an ECMO centre, or deployment of a mobile ECMO team to a referring hospital, is itself a high-risk intervention. The UK's NHS ECMO network comprises four commissioned adult centres and two paediatric centres.

The clinical relevance of ECMO to the current Andes hantavirus outbreak is direct. CDC HAN advisory HAN00528 (8 May 2026) noted that ECMO can improve Andes hantavirus survival to approximately 80% when started early, compared with the overall case-fatality rate of 30-50% in HCPS cases without early ECMO. US repatriates from the MV Hondius cluster were routed to the Nebraska biocontainment facility, one of a small number of US centres equipped to run ECMO inside a biocontainment environment simultaneously.