Everything you need to know about ECMO and COVID-19

How much do you know about the ECMO device that saves the lives of serious corona patients?

 Shaare Zedek hospital team members wearing safety gear as they work in the Coronavirus ward of Shaare Zedek hospital in Jerusalem on September 23, 2021. (photo credit: YONATAN SINDEL/FLASH90)
Shaare Zedek hospital team members wearing safety gear as they work in the Coronavirus ward of Shaare Zedek hospital in Jerusalem on September 23, 2021.
(photo credit: YONATAN SINDEL/FLASH90)

The pandemic’s fourth wave is declining, but the war on this virus isn’t over. According to data from the Health Ministry, around 50 COVID patients throughout Israel are connected to an ECMO device. Earlier this month, there was a record number of ECMO patients. How much do you know about the device that saves the lives of serious corona patients?

The fourth wave may be calming down, but it’s not yet behind us. 

Earlier this month, the Health Ministry announced that 58 patients are connected to ECMO and that Tel Aviv Sourasky Medical Center and Rambam Health Care Campus no longer have available ECMO equipment. These hospitals had to turn to other hospitals for ECMO machines. 

In Israel, there are currently about 82 ECMO devices used by critically ill corona patients, along with patients with various conditions who also need ECMO. The current shortage of these devices has caused many moral debates: Who is eligible for these life-saving machines? Those who have been vaccinated against corona or those with the highest chances of survival?

In recent days, when the fourth wave seemed to be fading a bit, the hysteria surrounding ECMO devices has somewhat subsided, but as was recently reported they’re still crucial, and we still don’t have enough of them. So what do you really know about the device that saved the lives of many corona patients? And why are there so few ECMOs in Israel?

What exactly is ECMO?

ECMO = extracorporeal membrane oxygenation. It is an external device that provides oxygen to a patient’s blood, similar to a heart-lung machine used during open-heart surgery, which allows a patient’s heart and lungs to rest. 

(Credit: Yonatan Sindel/Flash90)(Credit: Yonatan Sindel/Flash90)
How does the device work?

A thoracic/vascular surgeon connects a pump that takes venous blood (with little oxygen and lots of carbon dioxide) through a tube, passes it through an artificial lung that injects oxygen, pumps carbon dioxide and of course keeps the blood at a normal body temperature, and returns the “arterial” blood - rich in oxygen with less carbon dioxide - to the body.

Who needs ECMO?

A patient with acute and severe cardiac or respiratory failure that might be reversed can benefit from ECMO. Such conditions can be caused after a serious infection or an accident that damages the heart or has caused other health problems, but as mentioned these might be solved. Another reason could be as a “bridge” to the transplant of one of these organs.

How does ECMO help corona patients?

Severe corona patients may develop ARDS (acute respiratory distress syndrome). With this condition there’s respiratory failure and the lungs have difficulty functioning. In addition, this condition strains the heart, which has difficulty circulating blood through the affected lungs, and also there’s an overall lack of oxygen. ECMO is an artificial bypass device that allows the heart and lungs to rest.

A paramedic transports a COVID-19 patient to Mount Sinai Hospital in Toronto, in April 2020. (Credit: CARLOS OSORIO/REUTERS)A paramedic transports a COVID-19 patient to Mount Sinai Hospital in Toronto, in April 2020. (Credit: CARLOS OSORIO/REUTERS)

What is causing the shortage?

Aside from the fact that there’s a worldwide shortage of ECMO devices, the real difficulty is also in treating the patient connected to it. Patients may stay connected to the device for many days, sometimes weeks and even months. Moreover, each patient needs close monitoring that includes consistent testing of body metrics (pulse, blood pressure, temperature, blood oxygen saturation) and lab tests, such as blood and urine, even on an hourly basis. To do this, an ECMO technician must update the machine according to the patient's needs.

In addition, every such patient needs a nurse close by who cares exclusively for him or her. An intensive care physician must also be available to address complications at any time.

What complications may occur?

The mortality rate of those connected to ECMO is relatively high. Various studies suggest a patient’s age and also the length of time the patient is connected as risk factors.

The most common complication is bleeding. Incidents related to hypercoagulability, neurological complications and wound infection where the tube is inserted can also occur. Other complications include muscle weakness and aches which persist long after recovery from the disease. Studies also mention cognitive impairment including memory and concentration disorders.