Fit-for-Future: Lessons Learned from the COVID-19 Pandemic in Primary Extracorporeal Membrane Oxygenation (ECMO) Transports of Acute Respiratory Distress Syndrome (ARDS) Patients

(1) <b>Background:</b> The COVID-19 pandemic presented significant challenges in managing acute respiratory distress syndrome (ARDS), with extracorporeal membrane oxygenation (ECMO) being a critical but resource-intensive intervention. (2) <b>Methods:</b> This retrospective study analyzed veno-venous (VV) ECMO therapy in ARDS patients before and during the pandemic at a high-volume ECMO center in Germany. The study used a reduced ECMO team (one medical and one nursing specialist) to optimize patient care with limited resources, aiming to offer insights for future pandemic management. Data from 181 adult patients (age ≥ 18) with severe ARDS were analyzed: 57 pre-pandemic and 124 during the pandemic. (3) <b>Results:</b> Despite increased isolation measures during the pandemic (25% pre-COVID-19 vs. 79% during COVID-19, <i>p</i> < 0.0001), there was no significant change in transportation mode (ground vs. air) or ECMO implantation times at local hospitals. Similarly, time and distance for primary ECMO transport remained unchanged between the two periods. Complication rates related to ECMO circuit placement and prolonged transport were also insignificant across groups. However, ECMO therapy duration (median 12 days pre-COVID-19 vs. 19 days during COVID-19, <i>p</i> < 0.0001) and hospital stays (median 3 days pre-COVID-19 vs. 7 days during COVID-19, <i>p</i> < 0.01) were longer during the pandemic. Mortality rates were also higher during the pandemic (49% pre-COVID-19 vs. 65% during COVID-19, <i>p</i> < 0.05). (4) <b>Conclusions:</b> In conclusion, a reduced ECMO team proved to be an effective resource-saving strategy that maintained high-quality care with low complication rates, despite the additional challenges posed by pandemic-related isolation measures.