Dr. Shaun Thompson works with the sickest patients battling COVID at the Nebraska Medical Center.
When he talks to families about ECMO — which takes blood out of a patient’s body and adds oxygen to it before pumping it back in — he tells them, “Your loved one’s very, very ill, and I mean they are literally one of the sickest human beings in the city and state. Without this machine, they would not be here. They would be dead.”
The lungs are the primary target of COVID-19, said Dr. Brian Boer, section chief for the critical care division and the medical director of the COVID intensive care unit at the Nebraska Medical Center. But the disease — if severe enough — can cause multiple organs to fail.
People battling COVID can be started on supplemental oxygen to help them breathe, but if they still have trouble, they are placed on a ventilator. Putting a patient on ECMO is a last resort.
In patients with a severe case of COVID, Boer said, some people may feel as if they have just trekked up a flight of stairs even though they’re sitting still. Thompson compared the illness to treading water in the ocean.
“You finally feel like you’re catching your breath and then someone dunks you back underwater,” Thompson said. “And it’s all constant, all day, every day.”
In someone diagnosed with COVID, the lungs fill with fluid, making them stiff and inflamed.
The goal of ECMO is to allow the lungs to rest and recover so they again can do their job — oxygenate the blood.
Going on ECMO, or Extracorporeal Membrane Oxygenation, requires an invasive procedure performed by cardiac surgeons. Large tubes are inserted into the femoral vessels near the groin to drain blood from the body. The blood is then run through a machine that oxygenates the blood and returns it to the patient through a slightly smaller tube.
“It is a very complex interplay between the human body and the machine,” Thompson said.
On average with ECMO, two to three liters of blood circulate outside of the body and are pumped back in every minute. The number could rise to five or six liters depending on the severity of the case.
Patients are at risk of bleeding because of the large vessels accessed to perform the treatment, the blood-thinning medication patients are given and the potential for tubes to become dislodged. In addition to the risk of stroke, patients also are susceptible to infection.
Thirteen COVID patients have undergone the treatment at the Nebraska Medical Center, and seven have survived. Thompson said the med center currently is treating one patient on ECMO.
Since vaccines became available to the public, eight patients have been treated on ECMO, and all eight were unvaccinated.
Fewer than 500 patients are on ECMO in North American hospitals, according to the Extracorporeal Life Support Organization, which offers some guidance to doctors and facilities on what patients to treat with ECMO.
ECMO isn’t a commonly recommended treatment for COVID patients, Thompson said. It has about a 50% survival rate.
The treatment is offered in specialized centers across the country. In addition to the Nebraska Medical Center, ECMO has been used for COVID patients at Creighton University Medical Center-Bergan Mercy and at Lincoln-based Bryan Health.
Staffing shortages nationwide also limit how many patients can be on the treatment.
ECMO is labor-intensive, requiring cardiac surgeons, critical care physicians, specially trained critical care nurses, perfusionists, respiratory therapists, care techs, nutritionists and pharmacists.
Patients on the treatment require constant monitoring and specialized nutrition and medications because of the extra blood circulation.
The need for so much staffing has led the Nebraska Medical Center, which is dealing with a staffing shortage of its own, to stop making ECMO available to new COVID patients. Thompson said Wednesday that officials hope the pause is temporary.
Thompson said doctors from nine states, including Texas and Florida, have asked to transfer their patients to the med center for ECMO treatment. He has had to turn them all down.
ECMO typically is used to treat cardiac patients or patients with pneumonia or influenza who have developed acute respiratory distress syndrome, Thompson said. Those patients typically are treated with ECMO for four or five days. But for COVID patients, the average amount of time on the machines is two to three weeks.
Patients must meet strict criteria to be considered for ECMO. They should be fairly young — under age 65 — and shouldn’t have any major underlying conditions such as obesity, history of cancer or underlying lung disease, among other issues. Patients who have had other organs fail likely would be disqualified from receiving the treatment.
The average cost of admission to the hospital intensive care unit is about $75,000, Thompson said. ECMO treatment will tack on hundreds of thousands of dollars to the tab, Thompson said.
It’s a relief to see patients turn the corner and start to recover, Thompson said, especially after a labor-intensive treatment such as ECMO. Still, he said, it’s frustrating knowing that vaccines can help prevent severe illness caused by COVID-19.
“We want to save people,” he said. “When we know we saved someone from death by using this machine and giving them a chance, it’s a gratifying feeling. I wish we didn’t have to do it.”
Getting vaccinated is key in the fight against the disease, both doctors said. Vaccines have been proven to prevent severe illness caused by COVID-19.
“It’s pretty clear-cut who’s ending up sick right now,” Boer said. “It’s the people who aren’t vaccinated.”
“Vaccination is free. ECMO, ventilators are not,” Thompson said. “Our health care system is stressed. Our nurses are overworked. Our physicians are overworked. We’re all tired. There is a bona fide, proven therapy to avoid any of this, and it’s free. And it just requires two shots.”
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"You finally feel like you're catching your breath and then someone dunks you back underwater. And it's all constant, all day, every day."
Dr. Shaun Thompson, who works with the sickest patients battling COVID at the Nebraska Medical Center