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Article Category: Article

Unique Challenges for ECMO in this Pandemic

Dr. Asif Saberi

Published on September 20, 2021

Last updated 02:50 PM September 20, 2021

Illustration depicting ECMO treatment process

By Dr. Asif Saberi, Medical Director of Critical Care and ECMO at Wellstar Kennestone Regional Medical Center & Associate Professor of Medicine at Medical College of Georgia at Augusta State University

This wave of the pandemic is unique. We have learned a lot about COVID-19 as a disease, and we have more therapeutic options today than we did in the spring and summer of 2020. But the disease continues to humble us with its tenacity and increased deadliness with each new iteration or surge, and now with its onslaught on the young and the healthy, it is hitting us where it hurts the most.

As a system, we continue to struggle with limited human resources. There are not as many healthcare workers as we need and the steadfast warriors who have stayed at their posts through about 18 months of the pandemic are weary and burnout is high.

This is an important rate-limiting step in our ability to provide one specific therapy, viz., ECMO, which, for a significant number of young people in the extreme manifestation of the disease, is possibly the difference between life and death. At my institution, the phones have not stopped ringing and we maintain a long list of patients who need ECMO. The most heart-wrenching task for us is the daily sorting of our list, moving someone down and eventually off the list as their likelihood of benefit from ECMO and ultimately survival recedes with time.

This is a call to my colleagues in ECMO. Physicians, ECMO specialists, perfusionists, ethicists, and thinkers. As a breed, we are constantly thinking about solutions that are not in any book. Can we solve this problem?

Our ability to provide one specific therapy, ECMO, for a significant number of young people in the extreme manifestation of the disease, is possibly the difference between life and death.

- Dr. Asif Saberi

Wellstar Medical Director of Critical Care & ECMO

Access to ECMO

It cannot be stated enough that we do not have enough ECMO capacity for what our communities need today. While we need to increase the overall number of centers performing ECLS, this is not a good short-term solution. The ECMOVIBER study showed an increase in COVID-19 ECMO mortality on the Iberian peninsula during the second surge. This, the authors thought was to be due to an increase in ECMO use at newer and smaller centers. Our immediate need is to increase access to high-volume centers with experience in providing ECLS.

The recent struggles of a family trying to gain access to ECMO for their 30-year-old are emblematic of the issue. The family frantically called centers around the country. They found a center that would take him but needed someone local to cannulate him and asked us to help. Eventually, due to logistical reasons, the patient did not transfer to that center. The plight of his family was featured in the news on a local channel and another center reached out and accepting him. Should families and physicians have to resort to these extraordinary measures to find an ECMO program?

Or can we as an ECMO community provide a central resource that can be tapped by any of our colleagues caring for such a patient? Combine that with someone to coordinate authorizations, transport options, a network of local experts to call upon for cannulation, can we make a dent in this ECMO availability problem?

Longer length of stay & native lung function recovery

Pre-pandemic, our average ECMO length of stay (LOS) was less than seven days. During the pandemic, we estimate our average LOS is now more than twenty days. Some of these patients need support for much longer, even several weeks longer. During this wait, it is critical to maintain and preserve neuromuscular strength and cognitive function and prevent hospital-acquired conditions including nosocomial infections through excellent care.

At our center, we have advocated for and created a comprehensive list of services that we now use to achieve this important goal. These include an aggressive move to mobilize patients as early on ECLS as possible, early tracheostomy, incorporation of virtual and actual family interaction in care. These are, however, resource-intensive. But for those of our patients who have not recovered native lung function, such services were critical to demonstrating candidacy for transplant.

There is an opportunity for us to develop Long-Term ECLS Centers (LTECs), perhaps in collaboration with local transplant centers where we can consolidate these resources for the benefit of patients at several centers. This will have the benefit of unloading the ECMO centers, increasing ECMO availability, while providing the much-needed longer-term care some COVID-19 ECMO patients need.

None of us can solve this problem by ourselves or for ourselves. We need to do this as a community of ECMO providers in the U.S. and the world.

To learn more about how Wellstar is fighting the virus on the frontlines, visit our COVID-19 resource page.

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Asif Ali Saberi COVID-19 Pulmonary Care
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Illustration of a lung scan

Highlights

Wellstar Experts Collaborate to Help People Fight Lung Cancer

From catching cancer to following through with expert care, Wellstar ensures patients never have to fight lung cancer alone.

We are dedicated to early intervention in lung cancer, which improves outcomes for patients. After detection of an abnormality on a CT scan, patients are immediately surrounded by an interdisciplinary support team devoted to their well-being.

Identifying lung cancer early

If you are at increased risk for developing lung cancer, talk to your care team about screenings. With a low-dose CT scan of the chest, it only takes a few seconds to check in on your lung health. These screenings are offered at several Wellstar imaging centers.

The United States Preventive Services Task Force has revised lung screening guidelines. Patients may qualify for screening if they are 50 to 80 years old and smoked for 20 years. If they are a former smoker, they may qualify if they quit less than 15 years ago.

“Finding lung cancer early leads to better outcomes, and screening with CT scans is recommended as the only proven way to minimize delay in diagnosis,” said Wellstar Thoracic Surgeon Dr. Daniel Fortes.

Because finding cancer and starting treatment sooner can be life-saving, Wellstar has invested in one of the nation's largest lung screening programs and an incidental nodule program. When people come into a hospital seeking care for something else—whether that be a health condition like appendicitis or a traumatic event like a motorcycle accident—they might get a scan of the abdomen or chest that also shows portions of the lungs.

Using artificial intelligence, reports of those scans are fed to report coordinators, categorized based on their risk level and if a patient is higher-risk, forwarded to nurse navigators for review. Nurse navigators consult with physicians about the findings, and Wellstar can then initiate care if cancer is suspected.

The program, which started in fall 2020, has identified a total of 203 lung cancers and 22 other types of cancer, as of November 2025.

Expert care and support at every step

From the very beginning, people with lung cancer at Wellstar are surrounded by a team of experts. Rather than go through the time-consuming process of driving to multiple appointments with different specialists, patients meet with all these physicians in one place.

The Wellstar Lung Cancer STAT Clinic—at Wellstar Cobb, Wellstar Douglas, Wellstar Kennestone, Wellstar North Fulton, Wellstar Paulding and Wellstar West Georgia Medical Centers, as well as Wellstar Cherokee Health Park and the Thoracic NOW Clinic at Wellstar MCG Health Medical Center—give patients immediate access to specialists in medical oncology, radiation oncology, pulmonary medicine and thoracic surgery.

"We plan patients’ appointments ahead of time, ordering multiple tests that will be necessary for the treatment decision-making. These can include PET scans, CT scans, MRIs and/or a pulmonary function test," Dr. Fortes said. "We’re always gaining time in the patient’s overall treatment because we are anticipating and creating a plan as a team."

Getting multiple expert opinions from the start not only gives patients peace of mind, it speeds up treatment, too. In the United States, the average time between an abnormal scan and the beginning of treatment is 60 to 90 days. The STAT Clinic reduces that time to as little as 14 days. Time-to-treatment affects long-term survival in patients with lung cancer.

"We have data to show that if we delay treatment, even in early-stage cancers, we decrease the chance of a cure," Dr. Fortes said. "The goal of the STAT Clinic is to get them the quickest we can into their final treatment plan."

High-tech surgery options

For many patients, surgery is a crucial part of lung cancer treatment. Wellstar offers several minimally invasive options, reducing recovery time for patients.

More than 90% of lung cancer surgeries at Wellstar are performed using either the Da Vinci Surgical System or Video Assisted Thoracic Surgery techniques (VATS).

Minimally invasive surgeries reduce pain, scarring, blood loss and infection, as well as time to recover—getting patients back to work and other routines quicker.

The Da Vinci system is equipped with 3D cameras and instruments that can make very intricate, precise movements, allowing for shorter incisions and more accurate surgery. Some patients can leave the hospital as early as the next day.

For biopsies, Wellstar has completed 500 procedures using the Ion system, a robotic-assisted platform.

The system uses a three-dimensional spatial recognition technology that helps guide a catheter down the airway, deep into the lung, all the way to small nodules where biopsies can be performed. The robotic catheter maintains its shape and stability throughout the biopsy process, significantly improving diagnostic yield compared to other modalities.

"The better the image and the more certainty we have of the spatial location of the catheter, the better we can avoid complications by making sure we are not too close to a blood vessel or the edge of the lung," said Dr. Fortes.

To reduce your risk of lung cancer and keep your lungs healthy, talk to your primary care team and follow a few tips, such as exercising and avoiding smoking. Learn more about treatments on our lung cancer care page.

Keep reading
Patient getting CT scan

Highlights

Monitoring Your Lung Health with Cancer Screenings

Lung cancer screening can detect cancer earlier—even before symptoms show up. Earlier-stage cancers are more easily treatable. If you are at increased risk of developing lung cancer, you could benefit from regular low-dose CT scans to monitor your lung health.

“Finding lung cancer early leads to better outcomes, and screening with CT scans is recommended as the only proven way to minimize delay in diagnosis,” said Wellstar Thoracic Surgeon Dr. Daniel Fortes.

Our team has built one of the country’s largest and most comprehensive screening programs. Wellstar has been designated as a Screening Center of Excellence and Care Continuum Center of Excellence by the GO2 Foundation, an organization that supports lung cancer patients and educates about screenings and care. We’re also a designated Lung Cancer Screening Center by the American College of Radiology.

Evaluating your lung cancer risk

The United States Preventive Services Task Force has revised lung screening guidelines. You may qualify for screening if you are 50 to 80 years old and smoked for 20 years. If you are a former smoker, you may qualify if you quit less than 15 years ago.

“Those who are current or past smokers of cigarettes are more likely to develop lung cancer,” Dr. Fortes said. “However, while smoking is the leading risk factor for lung cancer, a large number of lung cancer patients have never smoked—1 in 5 women and 1 in 10 men diagnosed with lung cancer were never smokers.”

You may also be at increased risk of developing lung cancer if you have been exposed to radon, asbestos or other agents such as uranium or arsenic, according to the American Cancer Society. Previous radiation therapy in the lung area, such as chest radiation for breast cancer treatment, can also increase risk. Additionally, be sure to discuss your family history with your provider—siblings and children of people who have had lung cancer may have a higher risk of developing it.

Screening for lung cancer is not a one-time test, but a process that involves a periodic evaluation of your lungs over time to look for newly emerging cancer. CT scans can detect nodules that are compared over time for changes in size. 

“For those who are at high risk for lung cancer, it is best to have nodules and lung health evaluated by a team of physicians specializing in lung cancer care so the appropriate decision can be made of continued observation versus the need for early intervention,” Dr. Fortes said. 

Depending on the findings, some patients may have more or fewer exams. If findings are suspicious for lung cancer, your care team will contact you to discuss your screening results.

How do I schedule a screening?

An order from your physician is required to get a screening. Contact your primary care team or a pulmonologist to talk about screening and when it may be right for you. Once an order has been obtained from your physician, call (470) 793-4AIR (4247) to schedule your appointment.

What if my scan shows a lung nodule?

Your care team will support you at every step of the screening process. If you have any questions about your results or your screening plan, contact your provider over the phone or using the secure messaging feature in MyChart. You can also call our cancer care team at (877) 366-6032 to learn about our care options.

All lung screenings are initially interpreted by a radiologist. A team of physicians who specialize in the diagnosis and treatment of lung cancer will review findings that are suspicious for cancer. Once the physicians complete their review of your images, your results are posted within three to five days to your MyChart account. Results will be communicated with you and your physician via MyChart or mail within one week.

If a lung cancer is suspected, our team will call you to answer your questions and arrange next steps. You will then meet with a physician specializing in lung cancer treatment.

Patients whose screening shows a lung nodule may feel concerned. However, you should not be overly concerned if your report indicates you have small lung nodules. Most people who meet eligibility for screening will have some. Nodules are very common—at least 50% of people have them by the time they are 50 years old.

Learn more at wellstar.org/lungcancer.

Keep reading
Close up of man’s hands working on vehicle engine.

PeopleCare

BillyCare

William “Billy” Gerace, a retired man in Mableton, found himself progressively restricted by severe emphysema. Dependent on oxygen, it was tough to find the breath and the energy to work in his garage. Then he found out about BLVR, a procedure that would change his lungs—and his life—for the better. Now he spends his days breathing new life into classic cars. Billy’s story highlights the power of expert care and leading-edge treatments at Wellstar, and our commitment to help people get back to doing what they love.

 

Slowed down by an oxygen tank

For Billy, the simplest of movements became Herculean tasks. The man who loved tinkering in his garage found himself slowed down by an oxygen tank and dependent on his wife, Patty, to help him move it from room to room. 

“I couldn’t walk 20 feet without the hose on my nose,” Billy said. “I couldn’t go from the living room to the kitchen without oxygen. That’s how bad it was.” 

Billy suffered from emphysema, a severe type of chronic obstructive pulmonary disease (COPD). The inability to work in his garage on his collection of vehicles—including a '69 Corvette convertible—was heartbreaking. 

“I’d have to do five minutes’ worth of work—then catch my breath,” he remembered. “It took me a very long time to do anything. A project that would normally take an hour took two days. I had to sit dormant most of the time.”

Billy had managed this condition for years with prescription medication and pulmonary rehabilitation, but in the final months leading to his procedure, he had the impression that his life was fading with every gasp of air.

 
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