NASHVILLE, Tenn. (WKRN) — Early on in the COVID-19 pandemic ventilators were in short supply. Now a different treatment is in demand for the sickest of Covid patients. ECMO therapy is a last-resort treatment used when ventilators fail, and its use is rising across America as younger patients fill Intensive Care Units.
ECMO, which stands for Extracorporeal Membrane Oxygenation, is used for people who have serious illnesses that prevent their hearts and lungs from working properly. ECMO machines pump blood out of the body, add oxygen and remove carbon dioxide, and then put the blood back in. It’s a labor-intensive therapy that requires a team of specialists.
Vanderbilt Univerity Medical Center is a national leader in ECMO. But even at a large facility like VUMC, ECMO is still a valuable resource. “The hard part about ECMO is choosing the patients that we can help with ECMO and not hurt with ECMO,” said Dr. Todd Rice, the Medical Director of the Medical Intensive Care Unit at VUMC.
In addition to a limited supply of ECMO machines across the US, staffing can be a challenge. “Normally, in my ICU, a nurse is assigned to two patients and can take care of two patients,” said Dr. Rice. “A patient who’s on ECMO requires their own dedicated nurse, and often a special team that has dedicated ECMO, they’re called perfusionists, which take care of the pump, and a dedicated medical team that takes care of the patient also. It’s really, really, really labor-intensive.”
Treatment using ECMO is typically limited to larger facilities, “Many hospitals just don’t have the personnel or the expertise to do it. So it’s limited to a number of very specialized hospitals in the country.”
ECMO is also not an appropriate treatment for every patient. Older patients do not tolerate the treatment as well as younger patients. Often blood thinners are the issue, “One of the things that we have to do is we have to thin the blood as it’s going through the machine so that the machine doesn’t clot. And older patients tend to have complications from those blood thinners and they bleed more,” said Dr. Rice.
As younger, typically unvaccinated, patients fill emergency rooms, the demand for ECMO has grown. After all, younger patients are more likely to benefit. However, Dr. Rice warns that even this last-resort treatment isn’t always enough to save lives, “Our mortality rate is still 30 or 40%, for the patients that we put on ECMO.”
Patients may also require treatment for a prolonged period of time, “COVID because it’s so severe, and it’s so prolonged, our patients that go on ECMO are on for four, five, six weeks. We’ve had patients that have been on for three or four months on ECMO, that have survived.”
Even when this therapy is successful, patients are looking at months of intense therapy to regain their physical and mental function.