Unique Challenges for ECMO in this Pandemic

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.