New research published in the American Journal of Respiratory and Critical Care Medicine found that nearly nine out of ten COVID-19 patients who qualified for but did not receive ECMO (extracorporeal membrane oxygenation) died in the hospital due to a lack of resources.

Patients who were referred to Vanderbilt University Medical Center’s Extracorporeal Life Support Program (ECLS) between Jan. 1, 2021, and Aug. 31, 2021, were assessed in a study led by Whitney Gannon, MSN, director of Quality and Education for the ECLS program.

The analysis showed that despite the fact that both groups were young and had few comorbidities, 90% of patients for whom health system ability to offer ECMO was unavailable died in the hospital, compared to 43% of patients who received ECMO.

“Even when saving ECMO for the youngest, healthiest and sickest patients, we could only provide it to a fraction of patients who qualified for it,” says the lead author.

Once a patient’s medical eligibility for ECMO was determined, a separate assessment of the health system’s resources to offer ECMO was conducted.

When health-care resources such as equipment, people, and intensive-care unit beds were unavailable, the patient was not moved to an ECMO center and did not get ECMO.

Among 240 patients with COVID-19 who were referred for ECMO, 90 (37.5%) were confirmed to be medically eligible for ECMO and were included in the study. The median age was 40, and 25 (27.8%) of the participants were female.

The health system had the capacity to deliver ECMO at a specialist center for 35 patients (38.9%); however, the capacity to give ECMO at a specialized center was unavailable for 55 patients (61.1%).

15 of the 35 patients (42.9%) who had ECMO died before being discharged from the hospital, compared to 49 of the 55 patients (89.1%) who did not receive ECMO.

Overall, the risk of death for patients who got ECMO at a specialized center was roughly half that of those who did not.

“Because some patients die despite receiving ECMO, there has been debate about how much benefit it provides. This study shows the answer is a huge benefit,” adds senior author Jonathan Casey.

“This data suggests that, on average, providing ECMO to two patients will save a life and give a young person the potential to live for decades,” he concludes.

Source: 10.1164/rccm.202110-2399LE

Image Credit: Getty

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