From masks, to tests, to hospital beds, to ventilators. The ongoing COVID-19 pandemic continues to strain medical resources and personnel like never before.
Now, another life-support machine is in limited supply, and the shortage is sending desperate patients thousands of miles across the country and forcing loved ones to make hundreds of calls to nearby hospitals in the hopes of getting their hands 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 feeds it oxygen, then returning it to 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 only for those who still cling to life despite the use of all existing therapies, including mechanical ventilation and medications. It’s a complicated machine that requires a specially trained team of health care workers, so only some hospitals are equipped to carry them.
Stories of hopeless 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.
Because of limited supplies, some hospitals are making choices “similar to a combat medicine triage scenario,” Dr. Erik Osborn, a specialist in pulmonary critical care medicine at Inova Health System in Virginia, told the American Lung Association in January.
“In a setting where you have limited resources, you want to use those limited resources on the patients who are more likely to survive,” Osborn said. “By doing this, it allows us to save the largest number of lives, but that presents extremely challenging choices for health care providers to make.”
ECMO is often a ‘matter of life and death’
India Jones’s vaccinated husband has been fighting for his life in LaGrange, Georgia, since he contracted the coronavirus.
“He’s been on a vent for five days now,” Jones told CBS46. “He’s 31, healthy, never been sick and COVID pneumonia has really devoured his lungs. … ECMO could absolutely be a matter of life and death because his lungs have to have a chance to heal.”
Jones said she has “transformed” her home into a call center, “and we’ve been calling hundreds of hospitals all around the South.” It’s been about two weeks since her husband has been hospitalized with COVID-19; she’s 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 worldwide — told WUSF Public Media in August that “patients have been transported a lot of miles to get access to ECMO care. I think there was one recently in Florida that went up to Connecticut for care where there’s capacity right now.”
According to data from the ELSO registry, 7,581 COVID-19 patients initiated ECMO at least 90 days ago as of Sept. 16. The in-hospital mortality rate for these patients stands at 48%.
Survival rates for ECMO in the U.S. are estimated to be about 50%.
Why are ECMO machines in short supply?
ECMO involves a highly specialized machine. For that reason, the treatment is usually limited to larger hospitals, according to Dr. Todd Rice, the medical director of the Medical Intensive Care Unit at the Vanderbilt University Medical Center in Tennessee.
“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,” Rice told WKRN in August. Yet as more young, typically unvaccinated people contract severe COVID-19, the demand for ECMO rises, as they are more likely to benefit from and survive after ECMO treatment compared to older people.
ECMO requires specially trained personnel, too, who can manage side effects that range from bleeding to kidney failure, and the machines themselves.
“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,” Rice said. “It’s really, really, really labor-intensive.”
And it doesn’t help when other medical resources are strained.
“Across the country, we have all been limited by staff, equipment and even physical bed space. If you are going to put someone on a complicated machine, you want to make sure you have people that know how to take care of that machine as well as monitor the patient for any side effects,” Osborn of the Inova Health System in Virginia said. “There is a national shortage of nurses; so some places run out of nurses, then they may run out of ECMO machines, and finally they run out of actual beds. Over the last month, as expected, things have been getting worse.”
Another challenge: COVID-19 patients aren’t the only people who need ECMO treatment.
“There are people with heart failure, pneumonia and multiple other causes of lung failure that could benefit from ECMO,” Osborn said. “So, we have our regular patients and then on top of that we are adding COVID-19 patients and many of the ICUs around the country literally don’t have enough staff or beds.”