LEXINGTON, Ky. (LEX 18) — Hospitals are leveraging every resource available to help save lives during the pandemic.
One of those tools is extracorporeal membrane oxygenation (ECMO).
ECMO machines are one the most aggressive forms of life support available.
While ventilators can be a lifeline for severe COVID-19 patients, prolonged use puts a strain on the lungs. ECMO gives those lungs an opportunity to heal.
When severe COVID-19 patients continue to show low oxygen levels despite being placed on a ventilator, doctors may recommend ECMO to give the lungs a break.
“ECMO allows us, for most patients, to really turn the ventilator from very, very high settings to low settings and allow the lungs to rest and recover on the ventilator,” said Dr. Kevin Hatton, the chief of anesthesiology at UK HealthCare.
The ECMO machine works by pumping and supplying oxygen to the patient’s blood from outside the body.
The technology was originally developed in the 1960s to help pediatric patients with underdeveloped lungs get oxygen.
“COVID-19 has really forced us to use ECMO in very large cohorts very rapidly in times and places when historically we would not have been able to do so,” Dr. Hatton explained.
UK HealthCare owns 12 ECMO machines. Two machines are set aside for emergencies.
The hospital currently has 10 patients on ECMO---all are unvaccinated COVID-19 patients, according to UK HealthCare.
Dr. Hatton said before the pandemic it was rare to have more than two ECMO machines in use at a time.
“Since COVID has come around we’ve really exploded, quite frankly,” he said. “We’ve had to create a waitlisting system.”
There are four patients on the ECMO waitlist currently, according to UK HealthCare. Dr. Hatton said there were more than 20 on the list two weeks ago.
“We don’t have enough machines. We don’t have enough people,” Dr. Hatton said.
Every patient on ECMO needs one-on-one care from healthcare workers with specialized training. The personnel demand is challenging to balance, especially when hospitals are facing staffing shortages nationwide.
The ECMO waitlist is always in flux. A patient should ideally be on a ventilator no longer than seven days before going on ECMO, according to Dr. Hatton. The prolonged strain a ventilator places on the lungs may cause too many complications for ECMO to be useful after that time frame.
“As much as it can support their bodies for a short period of time, if their lungs are never going to recover then their lungs are never going to recover and ECMO doesn’t change that,” Dr. Hatton explained.
The Extracorporeal Life Support Organization is a non-profit working to collect data on the use and effectiveness of ECMO. The survival rate for COVID-19 patients placed on ECMO is less than 50 percent, according to the organization. The percentage has been dropping since the onset of the pandemic.
“It’s nowhere near where we want it to be, but the reality is COVID-19 survival is dramatically better than it would be without ECMO,” Dr. Hatton said.
Dr. Hatton said there are factors to consider when analyzing the data, including the length of time patients are on ventilators before receiving ECMO.
“Some portion of the reason why our outcomes may be drifting downwards is not because of ECMO or because of COVID-19,” he said. “It’s because of the overwhelming nature of the current surge that is over-utilizing our resources and stretching us all to our limits.”
