ECMO pumps blood out of the body, oxygenates it and returns it to the body
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khn.org
I fall in the more rare category of ECMO patients as one machine wasn't able to process/oxygenate enough volume safely to keep me alive and so I had two running in parallel - making my situation even more privileged by being at a hospital (Alfred Hospital - Melbourne, Australia) that had that availability.
I spent 7 days hooked up to the ECMO machines after my lungs failed due to Pneumonia > ARDS - and complicated by other organ failures. 19 days in total unconscious in ICU. You can read about my experience here - https://www.seriocomic.com/rhetoric/fragility
Clearly, the choice of this treatment/intervention should only be used in the most extreme cases and when there are few other options. But I'm all for having this type of life-saving medical treatment more widely available so that people less fortunate than I can continue to receive the gift of life.
When you mentioned that you needed two machines, I thought perhaps you were especially obese, but that does not appear to be the case from the pictures you shared.
Edit: Why am I being downvoted? I was curious about why two machines were needed? From the link he shared, he seems a normal sized male.
"Wednesday, 27th of August 2015 – Day 9
The nurse explained to me that they put another line in your neck, just to get extra line of blood to the lung machine as you need more oxygen to keep other organs working well. Your lung still is quite sick, the tube into your lung wasn’t working much comparing to the one from the lung machine."
A little more context:
"Monday, 25th August 2015 – Day 7
Your oxygen level requirement is 100% now, in case during night time at 3am, you need more oxygen, and there is no way they can feed you more here in Knox. So they need to cut a hole in your leg to put a man-made lung to pump extra oxygen in your body (as your lung is too inflamed), which can only be done in Alfred hospital."
A few years ago she got Legionella pneumophila and had to go in pharmacological coma for more than a month in order to survive, we were very lucky because my dad decided to not trust our GD and bring her to the biggest hospital in the city (only one of two with an ECMO in the whole country at the time).
I thank the amazing people working in medical research for this amazing device, had she got ill a few years before she would've surely died, instead thanks to human ingenuity she is still here, was able to see her son graduate and I hope we will be able to share many more years together. Seriously, if you work on these machines, thanks from the bottom of my heart and keep up the good work!
P.s.: What the actual fuck is up with the US and its medical costs? 4 million dollars for a stay hooked to this machine? We paid a grand total of 0€ for the whole stay, and after being in the ICU for close to two months my mom spent at least another three in the hospital. This is crazy, even if you add up a life time of taxes paid into the system by all our family members you wouldn't even begin to get close to that kind of number. I am truly convinced socialized healthcare is the only way forward, thinking that my mom could've been dead because we didn't have enough money in the bank sound so fucking dystopian
If you didn't pay for it, somebody did.
Why should a stranger be forced to pay for your medical care?
It's always nice to know that there are human beings around that would prefer not to pay a very small sum of money into the system in order to save the life of another human being because apparently taxation is theft. What kind of fucked-up world view is that? Do you really believe that the life of someone with a fat bank account has more intrinsic value than that of someone who is poor? Law and Healthcare should be the two things where everyone is completely equal and deserving of the same respect and care, the money you make should never dictate whether you live or die.
I really, truly hope you will never find yourself in the situation where a loved one's life is hanging by a thread, and that thread might be cut just because you ran out of money. If you can't emphasize with someone in that situation, or worse it, you can imagine yourself not caring or rationalizing the outcome, then I feel very sorry for you and hope you'll be able to find peace within yourself and learn to love other human beings a bit more.
The tax payers. It's a government service, just like policing or firefighting.
> Why should a stranger be forced to pay for your medical care?
You may want to revisit this question if you ever find yourself in need of medical care. Ultimately, it boils down to which way you prefer to play the game of life - in a cooperative way, or dog-eats-dog, you against the whole world way?
Those who don't want to pay for others usually leave for the US. I've known Europeans or Indians too who think there are too many havenots in their country who will be dependent on state for their care and they knew who will foot the bill, so they left for the US.
There are all kind of people, some prefer private healthcare because they want to receive cutting edge treatment for all money they've and there are some who want to receive free treatment even if cutting edge treatment is not feasible for all of them.
Ecmo is just now becoming (semi) widely adopted. Until recently hospitals had to cobble together their own systems from a collection of pumps, oxygenators, tubing and monitoring equipment. Only in the last few years have integrated systems and platforms come to market. These devices are in their first iterations, it's still early times. The hardware tech and medicine are both evolving rapidly and thus so is the standard of care. As is my experience with similar devices in the next ten years the ~50% survival rate will steadily creap up to above 80%, and the adoption will follow.
My experience in another, related space makes me very confident. LVADs, left ventricular assist devices awere once a sci fi dream and are now common, and extremely effective. People with what once was end stage heart failure are able to live for a decade or more having their heart supported by a tiny implanted pump the size of a F battery that spins at thousands of RPMs all day, every day. In many cases it's a better option than a heart transplant. It's so mainstream now that as of a few years ago the two most successful LVAD companies are now divisions of Medtronic and Abbott after large acquisitions.
Next up is ECMO and artificial hearts.
Anyone interested in whats next in this space should check out Ventriflo www.ventriflo.com, Bivavor www.bivacor.com and for some great history read "Ticker" by wired author Mimi Swartz.
There is so much more...
It's important to note that ECMO will NOT reverse disease in and of itself. This explains why some doctors believe that ECMO has no role in the treatment of patients with end-stage disease of any kind. Some even argue that ECMO amounts to cruel and unusual punishment. While I don't personally agree with the latter view, I do believe that we (doctors, patients, and their loved ones) must recognize ECMO for what it is: a means to an end.
While it's exciting to learn about technologies like ECMO, it would be a fool's errand to try to make it more portable, cheaper, etc. I strongly encourage the HN community to keep their eyes on the prize by applying their talent to discovering new ways to predict, prevent, and treat the conditions that land people on ECMO in the first place: - Heart disease - Diabetes - Cancer - Liver disease - Infectious Disease - Prematurity - Aging
P.S. - love to see medical stuff make it to the front page
Was the iron lung[0] only useful as a bridge?
Was there no reason to invent implantable pacemakers?
If you can enable a person to live a normal enough life outside of a hospital, I think this is a worthwhile goal. There are disabilities that make life more difficult to live than needing to carry around your heart/lungs outside of your body.
Ventilation on the other hand doesn't interact with your blood, but only has to handle air, which doesn't get damaged by the vent. So it is not impossible to be on a vent for decades. Being locked in the ICU for decades would not be good and luckily is not necessary.
I'll bet that over time the technology will improve and require less intensive management, and for every patient who ends up in an unpleasant twilight between life and death, there's going to be one whose short-term survival inspires doctors to find a way to get them off ECMO. Long-term survival and recovery rates will improve as the years and decades go by, and eventually technology like this will be a regular and uncontroversial part of medicine. Doctors will look back on these early days like we look back on early surgery: as the hardest part of a learning curve that eventually pays off handsomely.
ECMO is one of my most dreaded things to be put on. The other being marrow transplant. I've seen things in ECMO that have nothing to envy to the goriest of B movies.
That said, it's true that things are improving. ECMO results are nowhere nearly as bad as they were just 10 years ago around here. Or so it seems to me, at least.
What is up with that? - I don't know the problems around it.
The harvesting technique is now done using drugs like neupogen to mobilize the marrow stem cells into the blood stream where they can be collected in a process like dialysis. This is instead of having to actually extract marrow from the donor, which truly was barbaric, but I’m not sure if that’s done anymore.
The transplant process requires ablation (destroying the recipients existing cells) which I think can be done with chemo or radiation. It’s ~ a month in isolation to recover and the side effects of the ablation are also no fun but I’m not sure about “most dreaded”? There are probably some variations of the procedure which are much more difficult than others.
I've only ever heard from donors about how uncomfortable the donation process is.
But imagine living your life in a small isolation room for weeks at a time. With infection over infection, bleeding out from every hole, and with good-intentioned people sticking needles into you all day long. Then you die alone in the ICU.
We used to joke that it'd be softer to die from the primary cause than from the treatment.
One of the patients in the story was a 17 year old with cystic fibrosis. Iirc, CF accounts for a third of all adult lung transplants in the US and half of all pediatric lung transplants in the US.
One drug for CF costs $250k to $300k annually. Patients who get a transplant go through around a million dollars worth of medical care in the year of the transplant. Following transplant, they have to add antirejection meds to their typically long list of other drugs.
Some years ago, some estimates put the treatment for CF at $100k to $250k annually. Some members of CF discussion groups would then wonder out loud "Where did they get these figures? They sound crazy low."
At the time, life expectancy for CF was 36 years old.
Around that time, one mom said "My child with CF just turned 18. When they were born, life expectancy for CF was 18. Now, it's 36."
People who get transplants can also go into rejection, which sound like a pretty gruesome death from what I have read.
The ethics of who get these kinds of treatments is really complicated. It does everyone a disservice to view it through rose tinted glasses. It's just not that simple.
India makes those $300000 drugs for a few dollars a pack.
There is nothing wrong with invasive medical procedures. At one point C-sections were "an extreme medical intervention against the will of god" and just any medication was "prolonging ones suffering"
If you can keep a man alive indefinitely with that, do so.
Such grim attitudes of people in US keep reminding me that USA was of few places in the world on boat with eugenics and fascism before the WW2
FYI: I and my oldest son both have a diagnosis of atypical CF. So you are flippantly suggesting I be murdered for being knowledgeable about my own diagnosis.
Suffice it to say that isn't remotely the point I was trying to make. I just get tired of the ridiculous drama when I try to talk about improving my diet, changing my lifestyle and getting off all the maintenance drugs. No one is at all interested in hearing about such an approach, presumably in part because there are no fortunes to be made off of it.
There's that, but in the mean time (especially at US cost levels), the additional marginal cost added to the health care system is likely to kill a number of other people with eminently TREATABLE conditions, e.g. because they need to gamble with their insulin supplies for cost reasons.
What struck me was that the ICU is required for ECMO patients because they are at risk for other complications like blood clots. At what point do we have mobile wheel chairs of the 'Captain Pike'[2] variety where the wheel chair provides most of the organ functions for a person? And then where does that put us on the life/death scale? I can't help but think that practicing medicine is going to be even more complex ethically in the coming decades.
[1] The whole choosing when to turn off grandpa vibe is super depressing to me.
[2] Captain Pike - a character in the Star Trek pilot episode who was confined to a wheel chair that provided all functions, his only communication was a light that blinked once for yes and twice for no.
> "No, by the 24th century, no one will care."
https://boingboing.net/2015/07/08/star-trek-creators-perfect...
ECMO’s really an incredible feat of medicine that can bring people back from the edge where they would otherwise die.
My daughter was born in 2006 with meconium aspiration. Nurses hand-bagged her for 8 hours before taking her in ambulance to the nearest ECMO facility.
She was on ECMO for a few days, and miraculously recovered.
We took her to followup clinics every few months, expecting some sort of learning disabilities or lung damage. Turns out there were zero complications.
Today she is completely fine!
I really enjoyed Being Mortal by Atul Gawande (author of The Checklist Manifesto), that tells intensely personal stories about, well, the process of dying, and the increasingly prolonged tug of war between medicine and death.
One thing that may be a bit of a challenge is how quickly things change in the technology world. "Code Status" is medical lingo for the descriptor of what the patient expresses they want to have happen if their heart or breathing were to stop. Most people are full code - CPR, mechanical ventilation, etc. But patients can choose to be DNR/DNI, meaning "Do Not Resuscitate, Do Not Intubate", meaning very limited interventions would be performed.
As the tech gets better, I wonder if a more sophisticated decision tree might be needed in the future -- if XYZ happens where 30% of patients make a recovery, begin ECMO, but if ABC happens in which only 5% of patients recover, do not start ECMO.
Last summer a friend of mine had an accident while swimming at the beach, broke his neck, and spent six months on a a machine before he had a diaphragm pacemaker surgically installed. I visited him at a long-term care facility and there was a whole ward of people on ventilators.
I'm extremely grateful for the ability to breathe unassisted.
What would be really amazing is if we could replace defibrillators with these in stores, malls, etc... Instead of trying to restart someone's heart you have a system that's simple enough that a layperson can slap on a dying person to keep them alive while the ambulance arrives. Maybe in the form of a cuff that you clamp over someone's wrist that can use computer vision to identify veins and automatically insert the needles and run the machine. Too complex to be affordable with today's tech, but something that could definitely be possible in my lifetime I think.
There's a reason they put the lines in the femoral vessels - these cannulas are like hosepipes - you need to access the large vessels to get sufficient blood flow through the whole circulation.
The amount of flow needed to only sustain someone that hasn't been severely deoxygenated must be a lot less.
A smaller system might be able to initially infuse an oxygen-carrying booster (as Tour de France cyclists do) to get away with lower flow rates.
ECMO not only oxygenates, but pumps to assist the heart. Red blood cells would not resist infusion through small cannulas at high speed. Hemolysis already is a problem with the current size femoral cannulas.
So if what you're after is flow, size is a severe limitation.
I'm aware that's what's taught in med school, though. At the maroscopic level, it works ok.
Severe hypercapnia symptoms are bad.
What you describe only exists in very limited form in research labs.
Go take a look at an ICU ward, conscious or not these people are seriously unwell and as close to death as humanly possible.
Even the rich ones.
He was 'seriously sick', but he had a certain quality of life that was unusual for ECMO patients.
...The boy was fully conscious, doing homework, texting friends and visiting with family. But after two months of living in the ICU, he was diagnosed with untreatable cancer that made him ineligible to receive new lungs.
Clinicians were deeply divided over what to do next, Truog said. Some wanted to stop ECMO immediately because its original goal — a bridge to transplantation — was no longer possible.
Others argued that even though he couldn’t survive outside the ICU, the boy seemed to have a good quality of life on ECMO, and his family and friends “derived benefits from his continued survival,” Truog wrote. They argued that the family should have the right to continue this form of life support, just as with dialysis, ventilation or an artificial heart.
A third argument arose, Truog said: If leaving this patient on ECMO was appropriate, then in fairness “why don’t we put everyone with respiratory failure on ECMO?”
For the parents, Truog said, it was “unbearable” to choose a day or moment to turn off ECMO, because they knew their child would immediately die.
Clinicians devised an alternative the family would agree to: They decided not to replace the ECMO oxygenator, a part that needs to be changed every week or two when it develops blood clots. After about a week, the oxygenator gradually failed and the patient lost consciousness and died, Truog said.
The solution “allowed him to die in a way where we didn’t feel like we were choosing the moment of his death,” he said....
That's not an argument against, that's an argument for. Why don't we? The only reason not to would be cost.
The difference we are talking about with work is that a person gets paid if they do work, and doesn't get paid if they don't.
When someone is unwell enough to be placed in an ICU, it is important not to be flippant about suggesting they do things for money. Even putting aside the ethics of it, or the fact that in some caees additional burdens could literally kill them, if you get your worker to give your company an extra few thousand dollars value and that worker ends up taking an extra day in the ICU, how much do you imagine that extra day of ICU treatment costs? And what sort of other costs might there be that aren't captured in dollars?
Just whatever you do, make sure they did ask for it.
A fighter squadron was just about to take off from Ørland going to Rygge for training, and by chance one of the fighter jets was fitted with a cargo bay. They held that fighter jet back and re-routed it to Bodø, where machine was needed. A medical helicopter transported the machine from Trondheim to Ørland. From the helicopter landed at Ørland to the fighter jet delivered the machine at Bodø it took 40 minutes, a trip that usually takes 35 minutes alone. The machine arrived just before the trauma team.
The patient survived.
Was also wondering how long it will be before the tech is safe enough for healthy people. Is what you need for hi-G air and spacecraft if you don't want to be breathing liquid.
edit - your lungs would still be full of liquid, but apparently breathing liquid is not that great a plan, even though it is technically possible.
Could someone with more domain knowledge tell us if ECMO really is an entirely new paradigm like the article claims?
Edit: that's roughly $1800/hr for the stay I think
farms of blob babies that we extract blood from in order to ensure our eternal life
feeder bodies and then brains hooked up to the system, nobody will have a body, bodies will be like cars, or absent entirely
there'll be a transition phase where people still live in their bodies and are just doing blood changes like oil-changes, nightly while sleeping.
Almost $3,000 an hour!
[1] https://nurse.org/articles/highest-paying-states-for-registe...
I have been in higher risk renal wards and there are lot of people about even at night and that is a much lower risk ward.
I have also been in an ICU which has a lot more staff and I suspect that the USA probably has a higher staff to patient ration than the NHS
https://www.bbc.co.uk/news/uk-wales-45409281
Medical care in the US is seriously broken.
That appears to be a figure per course of treatment, not a figure per a day, so it isn't really directly comparable, unless we know the average duration of treatment as well (which is unlikely to be the same between US and UK)
So you would have to bring a supply of oxygen gas with you, and at that point you might as well get it into your body the old-fashioned way instead of relying on a dangerous and fiddly ECMO machine.