From masks, to tests, to hospital beds, to ventilators. The current COVID-19 pandemic continues to strain medical resources and medical personnel like never before.
Now another life-saving machine is in short supply, and the shortage is sending desperate patients thousands of miles across the country and forcing their loved ones to make hundreds of calls to nearby hospitals in the hope of making more. hand on one.
ECMO, or extracorporeal membrane oxygenation, is a machine that replaces the function of the heart and lungs by sucking blood out of the body, pushing it through an artificial lung that supplies it with oxygen, and then returning it to the body. the heart. The last resort procedure does not treat COVID-19, but allows patients to rest and recover enough to get off the machine.
The highest level of life support, ECMO machines are intended only for those who are still clinging to life despite the use of all existing therapies including mechanical ventilation and medication. It’s a complicated machine that requires a specially trained team of health workers, so only certain hospitals are equipped to transport them.
Stories of desperate loved ones have been reported since at least August in several states, particularly those in the South with low vaccination rates, including Alabama, Georgia, Tennessee, Florida, Texas and California.
Due to limited supply, some hospitals are making ‘similar to a combat medicine triage scenario”Dr. Erik Osborn, a pulmonary critical care medicine specialist at Inova Health System in Virginia, told the American Lung Association in January.
“In a context where you have limited resources, you want to use those limited resources on the patients who are most likely to survive,” Osborn said. “By doing this, it allows us to save as many lives as possible, but it presents extremely difficult choices for healthcare providers. “
ECMO is often a “matter of life and death”
India Jones’ vaccinated husband has been fighting for his life in LaGrange, Georgia since he contracted the coronavirus.
“He is i have been on a vent for five days nowJones told CBS46. “He’s 31, healthy, never been sick, and COVID pneumonia has really eaten up his lungs. … ECMO could absolutely be a matter of life and death because his lungs must have a chance to heal.
Jones said she had “turned” her house into a call center, “and we have called hundreds of hospitals across the South.” It has been about two weeks since her husband was hospitalized with COVID-19; she is still looking for a facility with an available ECMO machine.
Christine Stead, CEO of the Extracorporeal Life Support Organization (ELSO) – a nonprofit that tracks data on ECMO centers around the world – told WUSF Public Media in August that “patients have been transported many kilometers to have access to ECMO care. I think there was one recently in Florida who went to Connecticut for care where there is capacity right now.
According to data from the ELSO register, 7,581 COVID-19 patients initiated ECMO there are at least 90 days to September 16. The in-hospital mortality rate for these patients is 48%.
Survival rates for ECMO in the United States are estimated to be around 50%.
Why are ECMO machines rare?
ECMO involves a highly specialized machine. For this reason, treatment is usually limited to large hospitals, according to Dr. Todd Rice, medical director of the intensive medical care unit at Vanderbilt University Medical Center in Tennessee.
“A lot of hospitals just don’t have the staff or the expertise to do it. So it’s limited to a number of very specialized hospitals in the country, ”Rice told WKRN in August. Yet as more and more young, usually unvaccinated people contract severe COVID-19, the demand for ECMO is increasing, as they are more likely to benefit and survive after ECMO treatment than older people.
ECMO also requires specially trained staff who can handle side effects ranging from bleeding to kidney failure, as well as the machines themselves.
“A patient who is on ECMO needs their own dedicated nurse, and often a special team that has a dedicated ECMO, called perfusionists, who look after the pump, and a medical team. who also cares for the patient, ”Rice said. noted. “It’s really, really, really a lot of work.”
And it doesn’t help when other medical resources are strained.
“Across the country, we have all been limited by personnel, equipment and even physical bed space. If you’re going to put someone on a complicated machine, you want to make sure you have people who know how to take care of that machine and monitor the patient for any side effects, ”said Osborn of Inova Health System in Virginia. . “There is a national shortage of nurses; thus, some places lack nurses, then they may run out of ECMO machines, and finally they run out of actual beds. Over the past month, as expected, things have gotten worse.
Another challenge: COVID-19 patients are not the only ones who need ECMO treatment.
“There are people with heart failure, pneumonia, and several other causes of lung failure who could benefit from ECMO,” Osborn said. “So we have our regular patients and on top of that we are adding COVID-19 patients and a lot of intensive care units across the country literally don’t have enough staff or beds. “