As the Centers for Disease Control and Prevention reconfigures its masking guidelines to consider health systems, a recent study highlights the importance of keeping hospital capacity and resources at the forefront of pandemic strategy.
Researchers at Vanderbilt University Medical Center looked at how a shortage of ECMO machines affected COVID-19 patients at the height of the pandemic, according to the report published last week in the American Journal of Respiratory and Critical Care Medicine.
An extracorporeal membrane oxygenation machine, or ECMO, is a heart-lung device that pumps blood out of the body, removes carbon dioxide, and sends oxygen-filled blood back to the body, according to the Mayo Clinic.
Once a patient was determined to be medically eligible to receive ECMO, a separate assessment was performed to determine hospital resources. If resources were not available, the patient was not transferred to an ECMO center.
The team found nearly 90% of the 55 patients who were referred for ECMO between Jan. 1 and Aug. 31, 2021, but didn’t receive it, died in the hospital despite being young with few other health issues.
“Even when saving ECMO for the youngest, healthiest and sickest patients, we could only provide it to a fraction of patients who qualified for it,” said lead author Whitney Gannon, director of quality and education at the Vanderbilt Extracorporeal Life Support Program.
The pandemic saw a dramatic increase in requests for ECMO therapy, she said, with the medical center receiving up to 15 requests a day for critically ill patients.
It is used in critical care situations when a patient’s heart and lungs are severely damaged and need help oxygenating bodily tissues. The ECMO machine bypasses the heart and lungs, allowing these organs to rest and heal.
ECMO is a last resort therapy and patients who normally qualify have already been placed on a ventilator and received other interventions, Gannon said.
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While nearly 90% of patients in the study died in the hospital after not receiving ECMO, about 43% of the 35 patients who did get it died, suggesting the risk of death for patients who received ECMO at a specialized center was about half of those who did not.
“Because some patients die despite receiving ECMO, there has been debate about how much benefit it provides,” said senior author Dr. Jonathan Casey, assistant professor of medicine at Vanderbilt University Medical Center. “The data suggests that, on average, providing ECMO to two patients will save a life and give a young person the potential to live for decades.”
Although ECMO is a resource-intensive therapy that requires equipment, beds and experienced staff, Gannon said health systems should invest in the infrastructure needed to support it.
Dr. Douglas White, a critical care ethicist at the University of Pittsburgh, called the data “sobering” and said it also highlights the importance of public health measures to slow the rates of COVID-19 infection “before hospitals reach their breaking points.”
“Even in the United States, which has a well-resourced health care infrastructure, young patients died because there were not enough critical care resources to treat them,” he said.
The report emphasizes the importance of maintaining a sufficient supply of hospital resources and illustrates some real-world consequences of overwhelmed health systems, said co-author Dr. Matthew Semler, assistant professor of medicine at Vanderbilt University Medical Center.
“Throughout the pandemic, it has been challenging for many outside of medicine to see the real-world impact of hospitals being ‘strained,” he said. “This article helps make those effects tangible. When the number of patients with COVID-19 exceeds hospital resources, young, healthy Americans die who otherwise would have lived.”
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