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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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Doing good CPR is critical to save someone from cardiac arrest.

PeopleCare

KevinCare

There aren’t many people out there who can say they survived cardiac arrest at 30. Kevin Miskewicz can.

According to the American Heart Association, more than 90% of people who experience an out-of-hospital cardiac arrest die. Those who survive often have permanent neurological disabilities. But Kevin’s story has an incredibly fortunate ending, thanks to the highly coordinated work of his medical experts at Wellstar.

Recovering from cardiac arrest is something Kevin will never forget. It lives forever as a piece of his health history — one that includes a dedicated healthcare team — and his wife, who was the first to save his life.

There aren’t many people out there who can say they survived cardiac arrest at 30. Kevin can.

CPR to the rescue

Kevin woke up on Labor Day 2017 at 5:30 a.m. to take the dog out. Pausing to adjust the thermostat as he came in, he fell, knocking over a lamp.

He was in cardiac arrest.

With no symptoms and no known pre-existing condition, this was unexpected, but that didn’t stop his wife, Andrea, from jumping into action.

“If it weren’t for me knocking over a lamp when I passed out,” said Kevin, “she would have never woken up and saved my life.”

In addition to calling 911 and unlocking the door for the paramedics, Andrea performed CPR for 10 minutes.

“Kevin’s wife doing good CPR was critical,” said Dr. Arthur Reitman, the interventional cardiologist who was a vital part of Kevin’s treatment team at Wellstar Kennestone Regional Medical Center. “More than five minutes of poor blood flow to the brain can result in permanent irreparable injury from which a patient is unable to recover.”

Coordinating multidisciplinary care to save a life

When paramedics arrived at Kevin’s home, he had no pulse and was not breathing. As the paramedics performed their lifesaving work, he technically died two times.

The ambulance took him to Wellstar North Fulton Medical Center, where he was initially assessed and treated by Dr. David Jacoboff. The interventional cardiologist implanted an intra-aortic balloon pump to stabilize him. Then, he transferred Kevin to Wellstar Kennestone Regional Medical Center for highly specialized heart care.

When Kevin arrived at Kennestone by helicopter, his heart function wasn’t strong enough to support his body. Dr. Reitman and a team of doctors including a cardiologist, a pulmonologist and critical care doctors worked in tandem to put Kevin on an advanced life support system called veno-arterial extracorporeal membrane oxygenation. Better known as VA-ECMO, it took the heart “offline” so it could heal. The technology removed unoxygenated blood from his body, oxygenated it and pumped it back in for the next three days.

“Very few places in the state — only four or five hospitals — have the technology and specialized training to put a patient on ECMO,” Dr. Reitman explained.

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Illustration of person with thought bubbles representing staying home, pharmacies, virtual care, primary care and emergency care

Highlights

Feeling Sick? Know Where to Go to Get Care

Whether you experience an injury, minor illness or simply need a wellness exam, the most important step you can take is getting the care you need. That way, you can find trained experts for your specific medical needs, stay ahead of potential health issues or even help prevent your condition from worsening. 

With primary, virtual, urgent and emergency care services available, as well as retail pharmacies, how do you decide which type of care is best for your medical situation? Learn the differences between each type of medical service so you don’t delay and get care right away. 

I have been exposed to COVID-19 and I want a test: local pharmacy, stay home. I have a runny nose and fatigue: WellstarON virtual care, Wellstar primary care/pediatrician, Wellstar Urgent Care, local pharmacy, stay home. My child has a fever, decreased appetite and/or is wheezing: Wellstar primary care/pediatrician, Wellstar Urgent Care, Wellstar emergency room. I’m COVID-19 positive and have mild symptoms: WellstarON virtual care, Wellstar primary care/pediatrician, Wellstar Urgent Care, local pharmacy, stay home. I’m COVID-19 positive and have severe symptoms: Wellstar emergency room. I’m having trouble breathing: Wellstar emergency room. My child is having trouble breathing: Wellstar emergency room.   

Local Pharmacies 

If you are ill and have minor symptoms, over-the-counter medications can help you feel better. At your local retail pharmacy, you can find over-the-counter treatments for minor conditions like colds. If your symptoms worsen or do not go away with over-the-counter treatments, contact your primary care provider or visit an urgent care location. 

Local pharmacies also carry at-home COVID-19 tests, offering a convenient testing option for people who have been exposed or are experiencing mild symptoms of COVID-19. 

Virtual Care 

Whether you have a busy schedule or are just looking for a more convenient option, virtual appointments are an easy way to keep up with your health from anywhere. 

At Wellstar, we offer virtual visits with both primary care providers and specialists — no matter if you are an established patient or not. Connect with your Wellstar provider over the phone or with video on a computer, smartphone or tablet. 

If you’re an established patient, simply request a virtual visit through MyChart. If you don’t have an account, it’s easy to sign up for MyChart and keep all of your important health information in one secure space. You can also call your physician’s office directly and request a virtual appointment over the phone. 

These days, many types of appointments can be done virtually, including consultations, care for chronic conditions and prescription management. In addition to virtual primary and specialty care appointments, we also provide virtual urgent care through WellstarON for minor medical concerns. 

While virtual care is a convenient way to stay well, it should never be used in place of emergency care. If you are experiencing a life-threatening medical emergency, call 911 right away. 

Primary Care 

Primary care is ongoing, comprehensive care and preventative medicine that helps you live a full, healthy life. 

Your primary care provider — either an internal or family medicine physician, pediatrician or OB/GYN, depending on your age and medical needs — gets to know you and your health history on a deeper level. That means they have a more accurate view of your overall wellness. 

Services include: 

  • Annual wellness exams 
  • Health screenings, labs and imaging 
  • Care for chronic conditions, such as diabetes or high blood pressure 
  • Immunizations for children and adults 
  • Treatment for acute illness, such as the flu or colds 
  • Coordinating care with other specialists 
  • Physical and mental health concerns, such as weight loss or anxiety 

Find a Wellstar primary care provider in your neighborhood. 

Urgent Care 

If you’re dealing with a minor injury or illness or need care after your physician’s regular office hours, going to urgent care is often the right choice. Wellstar Urgent Care Centers provide quick, convenient care for non-emergency medical conditions. 

We also offer urgent care through WellstarON, which provides virtual health visits for minor medical concerns from the comfort and convenience of home. 

Wellstar Urgent Care provides: 

  • Care for minor illnesses and injuries, such as coughs, colds, sprains and broken bones 
  • Treatment for medical issues like bites, burns and cuts 
  • COVID-19 testing and evaluation for patients 12 and older 
  • Lab and X-rays 
  • Sports physicals 
  • Occupational health services 
  • Worker’s compensation services 

Find a Wellstar urgent care location near you or make a virtual urgent care appointment. 

Emergency Care 

In a life-threatening medical emergency, every second counts. Never put off getting the proper care when lives are on the line. Remember, driving yourself to the emergency department (ED) may delay care, so call 911 for the fastest access to emergency care. 

When the unexpected happens, Wellstar is always ready in a medical emergency. Our trained team provides expert emergency care 24 hours a day for people of all ages. We even have several pediatric emergency room locations, specifically designed to treat children. 

Recognize the signs of a medical emergency: 

  • Difficulty breathing or shortness of breath 
  • Chest discomfort or pain 
  • Severe abdominal pain 
  • Fainting or loss of consciousness 
  • Sudden dizziness, weakness or vision changes 
  • Sudden, severe pain 
  • Uncontrolled or severe bleeding 
  • Choking, coughing up blood or severe vomiting 
  • Suicidal or homicidal thoughts 
  • Changes in mental status, such as confusion or unusual behavior 
  • Traumatic injury due to a motor vehicle or other accidents 

Find a Wellstar emergency department close to you. Remember, call 911 right away in a medical emergency. That way, care can begin sooner during the crucial time it takes to be transported to the hospital. 

Keep reading
Illustration of Ion system

Highlights

Lung Biopsy Technology at Wellstar Reduces Complications, Speeds Up Treatment

Innovative technology at Wellstar is offering patients a new, minimally invasive option for lung biopsies, reducing complications and helping expedite lung cancer treatment.

The Ion system is a robotic-assisted platform for performing lung biopsies. If a lung cancer screening or any other CT scan shows a suspicious nodule, providers will need to perform a biopsy to determine if the patient has lung cancer and how to proceed with care.

“Those nodules may not be cancer, but in certain situations we still need to know what it is,” said Wellstar Pulmonologist Dr. Timothy Udoji. “The Ion technology helps us biopsy those nodules to get an answer so that additional workup can be done immediately. If it is cancer, we want to catch it at an early stage.”

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 Wellstar Thoracic Surgeon Dr. Daniel Fortes.

During the biopsy, providers can also use the Ion system to mark an area in the lung, making it easier to find later during surgery.

“If something is very small and hard to find in surgery, Ion can be used to mark that area with dye, or contrast, that allows us to find it in surgery,” Dr. Fortes said. “With this technology added to the surgical robotic system in the operating room, we can better identify those lesions and remove smaller portions of lung, also called segments.”

Technology to help provide peace of mind

The Ion system also has further reach than previous technologies and is able to more easily biopsy nodules in the peripheral areas of the lung. For many cancer patients, this will allow them to initiate care earlier and improve their outcomes, as well as give them peace of mind during the treatment process.

“Mental health impacts physical health. We are able to confidently biopsy and identify these nodules and that means a lot for our patients,” Dr. Udoji said. “Now, with this new technology we are able to get a biopsy done much earlier which has huge outcome implications for malignant nodules.”

At Wellstar, cancer care is tailored for each patient. In the Wellstar STAT Clinic for Lung Cancer, patients meet with multiple specialists at once to discuss their care options and create a personalized treatment plan. Specialists in the STAT Clinics, which are located at Wellstar Cobb, Kennestone, North Fulton and West Georgia medical centers, work with patients to determine the optimal course of treatment and will talk with patients and families about biopsy options, including the Ion system. The STAT Clinics give patients the opportunity to have their diagnoses managed right away, and literature shows that the clinics’ diagnostic and treatment model improves outcomes for patients.

The Ion system is currently in use at Wellstar Kennestone Regional Medical Center. Learn more about lung cancer care at wellstar.org/lungcancer.

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