Heart attack, cardiac arrest, respiratory failure, hypothermia. These and other medical emergencies can severely impair organ function and threaten life. These are also situations in which extracorporeal membrane oxygenation (ECMO) can be used to save lives.
Now, sequelae from COVID-19 can be added to the list.
Early on in the pandemic, the critical care and cardiac surgery teams at MedStar Heart & Vascular Institute at MedStar Washington Hospital Center applied ECMO technology to the most seriously ill COVID-19 patients—those who were on maximum ventilator support and nearing death.
ECMO effectively takes over the function of the heart, lungs, or both, drawing blood out of the body, oxygenating it, and recirculating it. Depending on the extent of the damage and the ability to recover, some patients may need it for only a few days while others may need to be treated for as long as several weeks. ECMO doesn’t fix the organs, but it provides valuable time for them to rest and heal.
To apply this technology to COVID-19 patients, the team adapted the usual ECMO indication guidelines to meet the emerging needs. Complex parameters were quickly developed, based on patients’ chances for survival. The intent was to exhaust other options, including maximum mechanical ventilation with pronation, before using ECMO. Patients determined to be candidates were transferred to the cardiovascular intensive care unit (CVICU). There, a full complement of critical care specialists—physicians, perfusionists, respiratory therapists, and nurses—treated and monitored patients throughout the course of therapy.
Building on a foundation of expertise.
Because of the tremendous amount of specialized experience required to operate ECMO, MedStar Washington Hospital Center is one of the few hospitals in the region that can offer the treatment. Patients throughout the region were transferred there to receive ECMO, putting the service well above its usual capacity.
The foundation of expertise allowed the team to quickly recalibrate its resources and processes in the midst of the pandemic.
The hospital added four ECMO systems to its arsenal, bringing the total up to 10 machines. An area within the CVICU was quickly converted to a negative-pressure unit for COVID-positive patients, effectively and safely separating them from the non-COVID patients receiving cardiovascular intensive care.
Intensivists in the CVICU are board-certified, critical care physicians with backgrounds in medicine, cardiology, infectious disease, pulmonary medicine, anesthesiology, emergency medicine, and surgery. This team, with years of experience in caring for a cardiovascular population, including using ECMO, was able to train additional support staff to assist during the surge.
Long-term outcomes for COVID-19 patients treated with ECMO are yet to be determined. Specialists at MedStar Washington continue to collaborate with providers across the globe, sharing data and best practices in an effort to fine-tune this sophisticated life-support treatment option. Nonetheless, the short-term results are remarkable: nearly 50 percent of the COVID-19 patients placed on ECMO at MedStar Washington survived to hospital discharge.