According to a study published in the American Journal of Respiratory and Critical Care Medicine.
The Vanderbilt University Medical Center (VUMC) study, led by Whitney Gannon, MSN, director of quality and education for the Vanderbilt Extracorporeal Life Support Program (ECLS), analyzed the total number of patients referred for ECMO in a reference region between January 1, 2021, and August 31, 2021.
About 90% of patients for whom the capacity of the health system to provide ECMO was not available died in hospital, compared to 43% mortality for patients who received ECMO, despite the young age of both groups and limited comorbidities.
“Even by reserving ECMO for the youngest, healthiest and sickest patients, we could only provide it to a fraction of the patients who qualified for it,” Gannon said. “I hope these data will encourage hospitals and federal authorities to invest in the ability to provide ECMO to more patients.”
Once a patient was determined to be medically eligible to receive ECMO, a separate assessment was made of health system resources to provide ECMO.
When health system resources – equipment, staff, and intensive care unit beds – were not available, the patient was not transferred to an ECMO center and did not receive ECMO.
Among 240 patients with COVID-19 referred for ECMO, 90 patients (37.5%) were determined medically eligible to receive ECMO and were enrolled in the study. The median age was 40 years and 25 (27.8%) were female.
For 35 patients (38.9%), the capacity of the health system to provide ECMO in a specialized center was available; for 55 patients (61.1%), the capacity of the health system to provide ECMO in a specialized center was not available.
Death before hospital discharge occurred in 15 of 35 patients (42.9%) who received ECMO, compared with 49 of 55 patients (89.1%) who did not receive ECMO.
“Throughout the pandemic, it’s been difficult for many people outside of medicine to see the real impact of hospitals being ‘strained’ or ‘overwhelmed,'” said co-author Matthew Semler, MD, Assistant Professor of Medicine at VUMC. “This article helps make those effects tangible. When the number of COVID-19 patients exceeds hospital resources, healthy young Americans die who would otherwise have lived.”
In total, the risk of death for patients who received ECMO at a specialist center was about half that of those who did not.
“Because some patients die despite receiving ECMO, there has been debate about the benefit it provides. This study shows the response is a huge benefit,” said lead author Jonathan Casey, MD. , assistant professor of medicine at the VUMC.
“These data suggest that, on average, providing ECMO to two patients will save a life and give a young person the potential to live for decades,” he said.
The study was funded by grants K23HL153584 and K23HL143053 from the NIH National Heart, Lung, and Blood Institute.