A shortfall in the cost of ECMO care during a Delta Surge

Speaking from his hospital bed at Vanderbilt University Medical Center in Nashville, Tennessee, James Perkinson’s voice rang out. In February, he underwent ECMO, the last -minute medical treatment where a machine outside the body works on the work of the heart and lungs.

Perkinson is expected to recover in a year or more.

“If it weren’t for the ECMO and the doctors appointed at the right time with the right knowledge, I wouldn’t be here,” he said, with his wife Kacie, at his side.

“Perhaps there is a miracle that he could have survived if he had not had it [ECMO]? Maybe. But there aren’t a lot of opportunities, ”Kacie said.

A new study from Vanderbilt suggests he may have been right about those times.

While the delta variant of covid-19 was on the rise at the end of last summer, ECMO therapy was short-lived in the South. The Vanderbilt team takes 10 to 15 calls a day from hospitals without ECMO looking for an open bed. The families of the sick are crying out for their loved ones who are dying.

“There is no place to sleep. There is no nurse. No machine. Not enough. We can’t be physical, ‘”nurse Whitney Gannon told people calling from hospitals around the South.” It’s the worst feeling in the world. “

But Gannon has grown a lot more with the diseases he converts on – more young and healthy people, according to Perkinson, who is 28.

Many of them died, including their pregnant women.

So within a few weeks, she helped start an official research project. And Gannon’s team began to take every phone call, even if there was no bed.

“We want to know: Is this patient really eligible for ECMO? Will we give ECMO? And if we don’t, we want to know who has that disease,” Gannon said.

The results, published in the American Journal of Respiratory and Critical Care Medicine, were devastating. Nearly 90% had no spot on the ECMO center that died. And these patients are under 60 and above healthy, with a median age of 40.

During the course of the disease, hospitals have difficulty determining what is the most important short -term ECMO, which stands for extracorporeal membrane oxygenation. It’s not a straightforward science. And the smaller the ECMO beds, the more likely it is that some patients continue for months on the machine, only to die.

Perkinson was a good candidate from a young age and – before contracting the disease with covid – healthy. A mechanic from Greenbrier, Tennessee, and a father of two, he caught covid after working for a while to get his first illness, he said.

Without the vaccine, she would not be well. He was put on a ventilator after Christmas and during the days he was on an ECMO mattress found his blood oxygen level dropped.

For nearly two months, his blood flowed through a tube in his neck to the ECMO unit, which injected oxygen, took in carbon dioxide, and returned it to his body. He was on rest all the time, increasing his risk of long -term physical injury and disability.

The use of ECMO has increased during chronic illness. Not much used, but the data is still there. And a study published in The Lancet in September 2021 found that the number of covid patients dying on ECMO had increased by 15% since the onset of the disease.

At first, only half survived. And as the disease progresses, more and more hospitals with less knowledge are using ECMO, as well as some promotions to treat chronic or chronic diseases. problems like fat don’t work together.

The focus of the debate on the need for ECMO is in a small community of nurses and respiratory therapists. And sometimes patients stay on medication for months, not just weeks.

One patient currently at Vanderbilt, seven ECMO beds, has been there since the delta increase last year, Drs. Jonathan Casey.

“So you can imagine how it’s not necessary to replenish this resource even during a small wave,” Casey said.

Even during the omicron surge, Casey said, Vanderbilt rejected some proposals for ECMO.

While the average life expectancy with severe covid disease is around 50-50, the Vanderbilt study shows what to do if medication is not available.

“I’m trying to convince people that this is a resource to invest and then hopefully people will invest those resources in time,” said Casey, lead author of the study.

Until ECMO is available, Casey said, the country will need to find a better way to determine what is the first choice for care, such as how to separate the treatment. cinema. There is a national ECMO organization called the Extracorporeal Life Support Organization, but it does not participate in experimental diseases.

Some hospitals will allow ECMO to try on anyone over 70, if the family insists. Others reject patients over 50, more likely if they have lower -grade diabetes or heart disease.

Small group efforts continue. In Minnesota, hospitals are allowed to use the same critical care costs and a statewide referral process.

Decisions continue to be “ethically nuanced,” Drs. Matthew Prekker, who helped set up the consortium before the outbreak of the disease. The combination may include giving an ECMO bed to a patient from the other side of the state rather than to someone at your own hospital.

The only goal is for more patients to survive.

“There needs to be interaction between the health systems and government leadership,” he said. “But I think doctors and the community are more interested now than ever before.”

This story is part of a partnership with WPLN, NPR, and KHN.

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