Hailey Tran
Extracorporeal membrane oxygenation (ECMO) is a form of life support that provides cardiac and respiratory support to people whose heart and lungs are unable to provide adequate oxygen, gas exchange, or blood supply. During the COVID-19 pandemic, the use of ECMO spiked, and it became a last-resort treatment for COVID patients with severe respiratory failure. However, ECMO machines were in short supply in many hospitals, leading to difficult decisions about patient prioritization. While ECMO can be a life-saving treatment, it requires significant resources, including experienced nurses and respiratory therapists, and patients may require prolonged treatment, sometimes remaining on the machine for months.
| Characteristics | Values |
|---|---|
| Number of ECMO machines in a hospital | Varies, but Vanderbilt University Medical Center has 7 ECMO beds |
| ECMO patient criteria | Generally, acute severe cardiac or pulmonary failure that is potentially reversible and unresponsive to conventional management. |
| ECMO during the pandemic | Used more than ever before, especially with the Delta variant. |
| ECMO survival rate | Around 50% for COVID patients. |
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What You'll Learn
ECMO machines are in high demand during COVID surges
ECMO, or extracorporeal membrane oxygenation, is a form of life support that provides cardiac and respiratory support to people whose heart and lungs are unable to provide adequate oxygen, gas exchange, or blood supply. During the COVID-19 pandemic, ECMO machines have been in high demand as they can provide lifesaving support for patients with acute respiratory distress. The use of ECMO spiked during the pandemic, with a 15% increase in the number of COVID patients dying on ECMO since the pandemic's beginning.
However, there have been shortages of ECMO machines, and hospitals have struggled with deciding who gets priority access. The criteria for ECMO initiation vary by institution, but generally include acute severe cardiac or pulmonary failure unresponsive to conventional management. Some hospitals have expanded their criteria to include older patients or those with risk factors like obesity. The limited availability of ECMO machines has resulted in a challenging ethical dilemma for healthcare providers, as they must decide who receives this potentially life-saving treatment.
The high demand for ECMO during COVID surges has also impacted staffing requirements. ECMO usage requires highly trained staff, including ECMO specialists, nurses, and respiratory therapists. The increased demand for ECMO has strained staffing resources, impacting the care of non-ECMO patients. The management of this strain has been particularly challenging for lower-volume, less-experienced ECMO centers. Regionalization of ECMO has been proposed as a potential solution to optimize the provision of care to ECMO patients.
Furthermore, the prolonged use of ECMO machines by some patients has further limited their availability during COVID surges. ECMO patients may require months of therapy, occupying beds that could otherwise be used for new patients. This prolonged use, coupled with the limited number of ECMO machines, has contributed to the challenging decisions hospitals face during COVID surges. Overall, the high demand for ECMO machines during COVID surges has highlighted the need for broader access to ECMO and improved methods for prioritizing patient treatment.
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ECMO treatment is costly and time-consuming
Extracorporeal membrane oxygenation (ECMO) is a highly specialised form of life support, providing cardiac and respiratory support to people whose heart and lungs are unable to provide an adequate amount of oxygen, gas exchange or blood supply. ECMO treatment is delivered by a perfusionist, a highly skilled professional who operates the ECMO machine in the intensive care unit (ICU).
ECMO treatment is a costly procedure. Firstly, the technology and equipment involved are expensive. The ECMO machine itself, as well as the various monitors and equipment used to support the patient's care, contribute to significant costs. Secondly, the procedure requires a large team of specialised healthcare professionals, including doctors, perfusionists, nurses, respiratory therapists, and other caregivers. The patient also requires constant monitoring and adjustments to the machine settings, further increasing labour costs.
The treatment is also time-consuming. ECMO is typically used for patients with severe and complex medical conditions, such as cardiac arrest, lung failure, or heart failure. When doctors successfully treat the underlying condition, ECMO treatment can be gradually tapered. This process is carefully done in stages to ensure the patient's heart and lung activity remain stable. Even after the patient is taken off ECMO, full recovery can take a year or more.
Furthermore, the duration of ECMO treatment can vary depending on the patient's response and the severity of their condition. Some patients may require ECMO for weeks or even months. The length of treatment impacts the availability of ECMO machines and beds in hospitals, especially during times of increased demand, such as the COVID-19 pandemic. The limited access to ECMO machines has led to challenging decisions regarding patient prioritisation, as hospitals struggle to meet the demand for this specialised form of life support.
In addition to the financial and temporal costs, ECMO treatment carries risks and potential complications. Patients on ECMO are at an increased risk of infections, with a prevalence of hospital-acquired infections of 10-12%, higher than that of other critically ill patients. The use of blood-thinning medication during ECMO can also raise the risk of bleeding in the brain, lungs, stomach, or at the sites where cannulas enter the body, posing life-threatening consequences.
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ECMO requires a large team of experienced nurses and respiratory therapists
Extracorporeal membrane oxygenation (ECMO) is a form of life support that provides cardiac and respiratory support to people whose heart and lungs are unable to provide adequate oxygen, gas exchange, or blood supply to sustain life. ECMO is a complex procedure that requires a large team of highly trained and experienced nurses and respiratory therapists.
ECMO patients are some of the most critically ill patients in intensive care units (ICUs), requiring an unparalleled level of care, support, and expertise. Each ECMO patient is typically supported by a duo of experts: a bedside registered nurse (RN) and an ECMO specialist. The bedside RN manages the patient's medication and monitors their vital signs, while the ECMO specialist operates and adjusts the life-support system. These two roles work together to provide seamless care and are often part of a larger team of healthcare professionals.
ECMO specialists come from diverse professional backgrounds, including registered nurses, respiratory therapists, and certified clinical perfusionists (CCPs). To become an ECMO specialist, individuals must first obtain the necessary education and licensure in one of these fields. For RNs and respiratory therapists, this involves completing an accredited degree program and obtaining the relevant certification. Additionally, it is essential for aspiring ECMO specialists to gain clinical experience in an ICU, preferably a Cardiovascular Intensive Care Unit (CVICU), to deepen their understanding of cardiac and circulatory systems.
The complexity of ECMO procedures and the critical nature of patient care require a large team of experienced healthcare professionals. During the COVID-19 pandemic, the use of ECMO spiked, and hospitals faced challenges due to limited ECMO machines and shortages of trained staff. The high demand for ECMO treatment during the pandemic led to a shift in strategy, with hospitals educating a broader group of nurses and respiratory therapists to care for ECMO patients, rather than relying solely on the most experienced staff. This collaborative approach helped manage the increased demand for ECMO and improved patient care.
In summary, ECMO is a complex and specialized form of life support that requires a large team of experienced nurses and respiratory therapists. The critical nature of ECMO patient care demands a high level of expertise and coordination among the healthcare professionals involved. By investing in education and training for ECMO specialists, hospitals can improve patient outcomes and save more lives.
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Hospital capacity crunches and patient criteria impact ECMO access
The use of ECMO machines spiked during the COVID-19 pandemic, particularly during the Delta variant surge, as it was used to support patients with acute viral pneumonia associated with COVID-19. However, the demand for ECMO machines often exceeded the supply, leading to hospital capacity crunches and difficult decisions regarding patient prioritization.
ECMO, or extracorporeal membrane oxygenation, is a form of life support that provides prolonged cardiac and respiratory support to individuals whose heart and lungs cannot adequately oxygenate their blood, exchange gases, or perfuse their organs with blood. It does so by temporarily drawing blood from the body, artificially oxygenating the red blood cells, and removing carbon dioxide before returning the blood to the body.
During the pandemic, hospitals faced challenges in deciding who should receive ECMO treatment when the machines were in short supply. This decision-making process is complex and ethically nuanced, considering factors such as age, health status, and underlying conditions. For example, some hospitals prioritize younger patients without underlying health conditions, while others may accept patients over 70 years old if the family strongly advocates for it.
The shortage of ECMO machines and the variation in patient criteria across hospitals have had significant impacts. Nurse Practitioner Whitney Gannon, who helped launch a study to examine access to ECMO machines during overwhelmed hospital periods, reported that many young and healthy patients who were turned away due to a lack of resources ultimately perished.
The limited availability of ECMO machines and the expansion of patient criteria to include older patients or those with risk factors have contributed to hospital capacity issues. ECMO requires a dedicated team of experienced nurses and respiratory therapists, and patients may require prolonged therapy lasting several months, further straining hospital resources.
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ECMO prioritisation is difficult and ethically nuanced
Extracorporeal membrane oxygenation (ECMO) is a complex and risky procedure that provides life support to patients with life-threatening illnesses or injuries affecting their heart or lung function. It involves extracting blood from the body, artificially oxygenating it, and removing carbon dioxide before returning it to the body. ECMO machines essentially do the work of the heart and lungs, allowing them to "rest" while doctors address the underlying cause of the failure or await an organ transplant.
The prioritisation of ECMO treatment is difficult and ethically nuanced due to several factors. Firstly, ECMO is a scarce resource with a limited number of machines and beds available in hospitals. During the COVID-19 pandemic, the demand for ECMO spiked, and hospitals struggled to meet the needs of all critically ill patients. This scarcity led to challenging decisions about who should receive ECMO treatment and in what order.
Secondly, the criteria for initiating ECMO vary by institution, and there is no standardised national protocol. Some hospitals prioritise younger patients or those without underlying health conditions, while others consider age and comorbidities less important. The lack of consistent criteria makes it challenging to determine who should receive ECMO when resources are limited.
Thirdly, ECMO treatment requires a multidisciplinary team of specialists, including perfusionists, nurses, and respiratory therapists. The availability and capacity of this specialised staff can influence the prioritisation of ECMO treatment. Hospitals with limited staff or those facing staff shortages may have to make difficult decisions about allocating ECMO resources.
Lastly, the duration of ECMO treatment varies significantly, with some patients requiring months of therapy. When patients remain on ECMO for extended periods, it further limits the availability of machines and beds for other critically ill patients. This prolonged use of ECMO resources adds another layer of complexity to the prioritisation process.
In conclusion, ECMO prioritisation is a challenging and ethically complex issue that requires careful consideration of multiple factors. While ECMO can be a life-saving treatment, the scarcity of resources, varying criteria, staff availability, and prolonged treatment durations all contribute to the difficulty of deciding who receives priority access to this potentially life-saving therapy.
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Frequently asked questions
ECMO stands for extracorporeal membrane oxygenation. It is a form of life support that does the work of the heart and lungs by temporarily drawing blood from the body, allowing for artificial oxygenation of the red blood cells and the removal of carbon dioxide.
The number of ECMO machines varies across hospitals. For instance, Vanderbilt University Medical Center has seven ECMO beds. However, during the Delta variant surge, Vanderbilt's unit received 10 to 15 calls per day from hospitals without ECMO looking for an open bed.
The availability of ECMO machines depends on various factors, including hospital capacity, the number of experienced nurses and respiratory therapists, and the demand for ECMO treatment in the area.
The duration of ECMO treatment can vary. While some patients may require ECMO for a shorter period, others may need to stay on the machine for months.
For COVID patients, ECMO is a last-resort respiratory treatment with a risky survival rate. Studies suggest that approximately only half of COVID patients on ECMO survive.
