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ECMO therapy cuts Covid-19 patients in half if they are likely to die.coronavirus

ECMO therapy cuts Covid-19 patients in half if they are likely to die.coronavirus


According to a new study by researchers at Vanderbild University, Covid- is provided by an advanced life-sustaining device called Extracorporeal Membrane Oxygenation (ECMO) and by an advanced life-sustaining device called Extracorporeal Membrane Oxygenation (ECMO). The risk of death from 19 is halved.

However, studies have shown that during the heyday of the pandemic, many patients were unable to receive treatment because they did not have enough beds, machines, or skilled staff to receive treatment.

Almost 90% of patients who met Vanderbilt’s strict criteria for receiving ECMO but could not receive treatment died.

“I think this is very powerful for me, because I was the first to actually see what was happening to these patients when I wasn’t receiving this treatment,” said Principal Investigator Whitney.・ Director Ganon said. Quality and education of adult ECMO programs in Vanderbild.

Ganon said he would receive 10 to 15 calls a day to patients in need of ECMO when the delta surge was the worst in the South. At maximum capacity, Vanderbild had space for seven EMCO patients at a time, so many of these patients were rejected.

“These patients were young,” Ganon said. “They weren’t chronic illnesses. They were young and healthy people who got Covid.”

Ganon said he often calls the next day to confirm patients who couldn’t be hospitalized, but only knows they have died.

These phones motivated Gannon to do research. This study was published in the American Journal of Respiratory and Critical Care Medicine.

The difference between life and death

ECMO works by circulating extracorporeal blood and supplying oxygen using tubes and pumps. Treatment takes over the heart and lungs and gives them time to recover.

Two 28-year-old fathers, James Parkinson, were one of the lucky ones. He was hospitalized two days before Christmas and his blood oxygen level was 82%. His condition deteriorated rapidly and he was placed on a ventilator.

Within a few days, it became clear to his doctor that there weren’t enough vents. His lungs were too damaged.

The hospital has a place for him and he started ECMO. He was connected to the machine for a month before they started pulling him apart.

Speaking from his hospital bed this week, his voice is still jarring because he has a tube in his trachea, and he knows how close he is to death. He said he wouldn’t have survived without the ECMO.

“Without it, I wouldn’t be here today. I would have been there long ago,” he said. “This is a lifesaver.”

Parkinson caught Covid-19 two days before he was scheduled to receive the first dose of the vaccine.

Prior to the pandemic, it was difficult to study ECMOs to see exactly how effective the treatment was. Patients who qualified for it were so ill that it was considered unethical for researchers to randomly assign seriously ill patients to go without it.

Despite these hurdles, a large group of international researchers attempted ECMO randomization studies in 2018. They divided 249 patients with acute respiratory distress syndrome (the same diagnosis faced by many Covid-19 patients) into two groups. The first group received ECMO and the second group was treated with mechanical ventilation.

To prevent anyone from being denied care, researchers allowed patients initially assigned to use a ventilator to switch to ECMO if treatment failed. Results could be confusing as about a quarter of the group using ventilators eventually moved to ECMO. Most of the people who were switched (20 out of 35) died.

the studyThere was no difference in the results of people assigned to ventilators or ECMOs in the New England Journal of Medicine, and doctors wondered if patients were really good with more aggressive and expensive treatments. rice field.

Severe situations measure the value of treatment

At Vanderbild, doctors realized that patients did not need to be randomized to study ECMO. The pandemic was doing it for them. The treated patient was treated because of bad luck.

Someone called them the day the hospital happened to have an open bed, but it was rare. Covid patients can stay in ECMO for more than a month.

Dr. John Casey, a pulmonologist at Vanderbilt University, said, “This is what we were experiencing in a very visceral way, and it feels like it’s unknown to the general public. I did. “

“We will get calls from other doctors, and as you know, we were their tenth phone looking for this,” Casey said. “And it was really hard to get those calls.”

Casey said the experience of Vanderbild was not uncommon. “I think this is exactly the same experience at all ECMO centers in the country,” he said.

Gannon and her team have collected information about all patients referred to Vanderbilt for ECMO for eight months.

Treatment was so limited that Vanderbild was forced to distribute it. They did not consider those over the age of 60, those with an obesity index above 55, or those who have been on ventilator for more than 7 days. The patient was unable to suffer from brain damage, chronic lung disease, cancer, or organ failure. Having one of those strikes against you was automatically no.

The center considered patients over the age of 50 only if they also had no other two risk factors: obesity index greater than 45, renal failure, ventilator for more than 4 days, drugs to support blood pressure He had been on the drug for more than 2 weeks or was 4 weeks away from Covid’s diagnosis.

By the end of August 2021, 90 patients were considered eligible for medical treatment. Vanderbilt took 35 of them. They had to turn their backs at the age of 55.

Of the ECMO group, 43% died in hospitals, 89% of patients who could not be transferred, and 49 of 55 died.

“Therefore, among this very small group of people, these young people who are really sick and have few health problems have reduced their risk of death by about half,” Casey said.

ECMO doesn’t just require special machinery. It also depends on having people who know how to do them. Each ECMO patient requires a dedicated nurse and a team of respiratory therapists and physicians to monitor treatment. Ganon said that in many cases, having as many people as the equipment was the reason why we couldn’t accept more people.

Prior to the pandemic, Casey said Vanderbild had a young ECMO program. They had the ability to care for only two patients at a time. But when the needs were greatest, they more than tripled their abilities.

“It was a pretty impressive resource expansion at the moment of the crisis, but it wasn’t enough. There was a time when we were alienating two, three or four times as many patients as we could accept.” He said. The situation that caused moral trauma to the team because they knew that each life depended only on “yes” or “no” from them.

James Parkinson was successful, but he has a long way to go. He said he needed to relearn “everything”, how to eat, drink, walk and move his arms. But at least he has the opportunity to see his children again, and he is grateful for that.

“It’s a miracle,” he said. “And to be honest, it hurt me because I took someone’s second chance.


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