Dubai, United Arab Emirates (CNN) — For severely ill patients, an advanced form of life support, a technique known as extracorporeal membrane oxygenation, or ECMO, cuts the risk of death from COVID-19 in half. According to a new study conducted by researchers at Vanderbilt University, USA.
The study found that at the height of the coronavirus pandemic, many patients were unable to get treatment, as there were not enough hospital beds, equipment or staff to care for them.
About 90% of patients who met Vanderbilt University’s stringent criteria for ECMO but were unable to receive it died.
“I think this is very important to me, because for the first time, we were actually seeing what happens to these patients, when they don’t receive this treatment,” said study lead author Whitney Gannon, director of quality and education for the adult ECMO program at Vanderbilt University.
When the delta wave was at its worst in the South, Gannon noted, she received 10 to 15 calls a day about patients who needed ECMO.
At a maximum, Vanderbilt University had enough capacity for 7 patients to receive EMCO simultaneously, so they could not receive many of these patients.
Gannon pointed out that these patients were young, and did not have chronic diseases, and added, “They were just healthy people and young people who were infected with Covid-19.”
Gannon would often call the next day to check on the health of patients she could not receive, only to discover that they had died.
Those phone calls prompted Gannon to conduct the study, which was published in the American Journal of Respiratory and Critical Care Medicine.
The difference between life and death
ECMO technology works by using tubes and pumps to circulate and oxygenate blood outside the body. The treatment takes care of the heart and lungs, giving both organs time to recover.
James Perkinson, a 28-year-old father of two, was among one of the lucky ones who got the chance to be treated with ECMO.
Perkinson was admitted to the hospital two days before Christmas with blood oxygen levels of 82%. His condition quickly deteriorated and he was placed on a ventilator.
Within a few days, it was clear to his doctors that his respirator would not be enough, as his lungs had been severely damaged.
Fortunately, ECMO was available at the hospital, and Perkinson was attached to the devices for a month before doctors began rehabilitating him.
Perkinson is speaking from his hospital bed this week, his voice still hoarse from a tube in his windpipe, as he knows how close he is to death, noting that without ECMO, he wouldn’t have survived.
“If it wasn’t for that, I wouldn’t be here today,” he said. “I would have been gone a long time ago, it’s a life saver.”
Perkinson contracted “Covid-19” two days before he was scheduled to receive his first dose of the vaccine.
Before the pandemic, it was difficult to study ECMO to see how effective the treatment was.
Patients who qualified for this technique were so ill that it was unethical for the researchers to randomly assign any critically ill patients.
Despite these obstacles, a large group of international researchers attempted a randomized study of ECMO technology in 2018.
The researchers divided 249 patients with acute respiratory distress syndrome – the same diagnosis many Covid-19 patients face – into two groups. The first group received ECMO technology, while the second group was treated with mechanical ventilation.
So that no one would be denied care, the researchers allowed patients who were first assigned to a ventilator to switch to ECMO technology, if their treatment stopped working.
About a quarter of the group on respirators eventually switched to ECMO, which may have spoiled the study results.
The study, published in the New England Journal of Medicine, found no difference in outcomes for people assigned to a ventilator or to ECMO, leaving doctors to wonder if their patients fare better with the more aggressive and expensive treatment.
Grim conditions measure the value of treatment
At Vanderbilt University, doctors realized they didn’t need to randomly select patients for an ECMO study, as the pandemic did, and patients who received treatment got it out of luck.
For eight months, Gannon and her team collected information on every patient referred to Vanderbilt University for ECMO treatment. Since the treatment was so limited, the university had to legalize it.
The university did not consider taking anyone over the age of 60, those with a body mass index greater than 55, or anyone who had been on a ventilator for more than seven days.
Patients cannot have brain damage, chronic lung disease, cancer, or organ failure. Having any of those cases was an automatic refusal.
By the end of August 2021, 90 patients were considered medically eligible for ECMO treatment, Vanderbilt received 35 of them, and had to decline the remaining 55.
Among the group receiving ECMO treatment, 43% died in hospital, while 89% of patients who could not be hospitalized died, i.e. 49 out of 55.
ECMO does not only require special hardware, it relies on having people who know how to manage it.
Each patient treated with this technique needs a dedicated nurse, as well as a team of therapists and doctors to monitor the treatment. Oftentimes, staffing as much as equipment, Gannon said, was the reason they couldn’t take in more people.
Patient James Perkinson has made progress in treatment, but he has a long way to go. He said he had to relearn how to eat, drink, walk and move his arms. But at least he had the chance to see his two children again, and he’s grateful for that.
Perkinson added: “This is a miracle, and frankly, it pains me to think that I might have taken someone else’s life.”