- Patients placed on the ECMO life-support system in the second half of 2020 were more likely than those who died during the first wave of the pandemic, a new study finds
- ECMO is extracorporeal membrane oxygenation, a life-support system that aids in a person’s blood circulation.
- Those placed on ECMO before May 2020 were 37 percent more likely to die within 90 days, compared to 52% in the same hospitals in the following year
- Researchers believe the increase is due to less efficient decision-making hospitals with resources
- ECMO is intensive, requires multiple materials and constant supervision for patients, and many people receiving it have already received intensive medication.
A new study shows that COVID-19 patients who needed life-support in late 2020 were more likely to die within 90 days than those placed during the first wave of the pandemic.
Researchers at the University of Michigan Ann Arbor found a sharp reduction in survival rates for patients placed on extracorporeal membrane oxygenation (ECMO), a system used to treat patients in critical illness and assist in the circulation of blood.
They found that patients placed on ECMO at the start of the pandemic survived for at least 90 days under 63 percent of the circumstances.
Later, however, the survival rate decreased by 40 percent, with less than half of those placed on ECMO from May to December 2020 surviving for 90 days.
Researchers believe that with ECMO there has been a sharp increase in deaths due to poor resource management.
The researchers found that patients placed on ECMO at the start of the epidemic (blue line) had a significantly lower mortality rate at 90 days than those placed on life support (green and red lines) later.
The researchers believe that hospitals could have managed resources better in the second half of 2020, avoiding using valuable resources on patients who died anyway. Image: A physician assists a COVID patient at the hospital in Farmington Hills, Michigan on December 17
Study co-first author and intensive care physician Dr. Ryan Barbaro said, “What we immediately saw is that patients treated later in the epidemic were staying on ECMO longer, on average 14 days to 20 days. were going.” Michigan Medicine, in a statement.
‘They were dying more often, and these deaths were different’
‘This suggests that we need to be thoughtful about who we are applying ECMO to and when we are making the decision to remove patients who are not getting better. Right now across the US, we have places where ECMO is a scarce resource.’
For the study published at the end of last month the LancetData were collected from 4,800 patients from 41 countries.
Patients were divided into three groups, one for patients who were considered ‘early adopters’ in hospitals receiving ECMO before May 2020.
A second group was for patients placed on ECMO in the same initial adapter hospitals after May.
The third group were patients placed on ECMO after May in hospitals that had not used life support systems earlier in the pandemic.
In the first early adopter group placed on ECMO, more than a third, more than 37 percent, died within 90 days of being placed on the system.
Between May and December of 2020, this figure increased to 52 percent in the same hospitals.
In hospitals that were not early adopters, 58 percent of patients died within 90 days of receiving ECMO treatment.
Placing a patient on ECMO is a very intensive process that can absorb many medical resources.
The system itself requires a number of materials, such as tubes, pumps and oxygenators, and the patient must remain under the supervision of medical professionals.
All of these resources being invested in patients, where they may not be effective, harm the entire hospital – and all patients admitted there.
Patients who were placed in ECMO after May 2020 were also given non-invasive procedures such as receiving drugs like remdesivir and were also put on ventilators – which requires a lot of hospital resources.
Doctors will do whatever they can to ensure this, no matter how many resources are spent, but in times where that is not enough to make difficult decisions, they have to.
Patients who have family members present are also more likely to receive more intensive treatment because they have people with advocacy doctors.
Researchers want hospital systems to set clear guidelines for when a patient receives resource-intensive procedures in order to make better use of limited resources.
Hospitals should also work to help each other to overcome resource constraints.
‘In these moments of crisis, our ability to meet demand presents ethical challenges, and COVID has exposed the weaknesses of our system, while also showing how with the resources and relatives who are on their behalf. Advocates can, they are more able to find out about it. Look for the opportunity to ECMO and treat your loved one,’ Barbaro said.
‘Meanwhile, hospitals in non-growth areas need to reflect on what policies and procedures they can use, if they experience another surge, to promote ethical allocation when resources are scarce. will do.’