Why don't they use ECMO machines to oxygenate blood outside the body for covid19 patients?

[Quixote1818]

Do they not manufacture many of these? Seems if your lungs are filled with fluid and no longer working this would be the thing to do. I am sure there is something I don't understand. Just curious as to what that is.

Snip: It pumps and oxygenates a patient's blood outside the body, allowing the heart and lungs to rest. When you are connected to an ECMO, blood flows through tubing to an artificial lung in the machine that adds oxygen and takes out carbon dioxide; then the blood is warmed to body temperature and pumped back into your body.

https://www.ucsfhealth.org/treatments/extracorporeal-membrane-oxygenation

[hlthe2b]

1. They do and have in many severe cases. Varying success.

ARDS Adult Respiratory Distress Syndrome is the most serious complication of COVID-19 and is a hallmark of other serious infections including Hantavirus Pulmonary Syndrome(and some acute inflammatory conditions, including severe pancreatitis). ECMO has long been used on these patients, with varying success. Frankly, it is resource and staff intensive and probably not feasible to use in many cases. By the time it is brought on, it may already be too late.

[Runningdawg]

2. That's called killing a fly with a sledgehammer

They would need to be put on a ventilator to keep them alive during the surgery to place them on ECMO. I retired from the largest hospital in OK. We probably had 500 respirators but only 4 ECMOs. Also by taking the ECMO, you would be denying those waiting for heart and/or lung transplants ANY chance at that option.

[Quixote1818]

3. So probably only super wealthy and powerful people will get them I bet. nt

[Bernardo de La Paz]

5. Chinese proverb: Do not use an axe to remove a fly from your friend's forehead. . . . nt

[jberryhill]

4. What is it that makes you believe they aren't?

Link to tweet

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Link to tweet

?s=20

Rationing runs deeper than ventilators & PPE. Some #COVID19 patients may receive extracorporeal membrane oxygenation (ECMO), or cardiopulmonary life support, as an adjunct to ventilation & medical mgmt. ECMO therapy can be life saving but it's hardly guaranteed (1)
7:01 PM · Apr 6, 2020·Twitter Web App
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Rizzo: Unchained
@A2thaRizzo
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17h
Replying to
@A2thaRizzo
ECMO is an advanced therapy option offered by 859 centers worldwide, with 304 in the U.S. alone (src: http://ELSO.org). It requires a highly-skilled team of critical care specialists (MDs, perfusionists, RNs, RTs, etc). Successful outcomes depend heavily on experience (2)
Rizzo: Unchained
@A2thaRizzo
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17h
Above staffing, this therapy is resource intensive. ECMO pumps are mini-cardiopulmonary bypass machines, siphoning blood outside the body, performing gas exchange (O2 delivery, CO2 removal), and pumping the blood back into the patient's circulation (3)
Rizzo: Unchained
@A2thaRizzo
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17h
These machines ain't cheap. ECMO pumps run anywhere from $40K-110K+ for hardware alone. Tack on another $2K-13K+ for circuit disposable costs. Bear in mind, ECMO circuits need to get changed out every several days for fibrin deposits, clot formation, and loss of efficacy (4)
Rizzo: Unchained
@A2thaRizzo
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17h
Not every #COVID19 ICU patient is a good candidate for ECMO. The ELSO consortium provides guidelines as to who qualifies (see algorithm attached). But with limited resources and competent staff, physicians are left having to ration pumps, effectively playing God with care (5)
Rizzo: Unchained
@A2thaRizzo
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17h
Per ELSO guidelines, high-priority patients include younger ARDS patients with minimal comorbidities (at my center, #CV19 ECMO patients are all <45 y/o) and COVID-infected healthcare workers. Patients with multi-organ failure or >7 days on a ventilator may be excluded (6)
Rizzo: Unchained
@A2thaRizzo
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17h
Under normal conditions, the use of ECMO for pulmonary distress has a survival rate of 60% (src: ELSO 2019 Registry). ECMO therapy in #COVID treatment is still in its infancy but we are learning more about its utility each day. Frontline workers, like me, are hopeful! (7)

[WhiskeyGrinder]

6. ECMO has saved the lives of two patients. But it's unclear what their quality of life will be.

There aren't that many machines and only certain people qualify for it.