ECMO – what is it, how does it work, when does it help? It is risky, very expensive, it does not heal, but it saves lives

ECMO is risky, does not heal and costs a lot. The mere connection to it costs about 50 thousand. PLN, and this is just the beginning of expenses. However, ECMO can save a life and is therefore called “last resort therapy”. It lasts at least a month, but maybe also several months. This was the case with a patient of the hospital of the Ministry of Interior and Administration, who spent nearly 140 days at ECMO. – This is a record in Europe and in the world – said prof. Piotr Suwalski, head of the local cardiac surgery clinic. What is ECMO, how does it work, when is it used and how much is monthly therapy with it? We explain.

1. ECMO is a type of lung and / or heart prosthesis. It is a technique of extracorporeal blood oxygenation and elimination of carbon dioxide from it
2. ECMO allows you to replace the work of these organs only for a certain period of time – i.e. until their functions improve, allowing for independent work
3. ECMO therapy lasts at least a month in patients around 40 years old. It takes this time for the lungs to regenerate. At the Central Clinical Hospital of the Ministry of the Interior and Administration, there was a patient who spent about 140 days under ECMO, i.e. almost five months. – This is a record in Europe and in the world – said prof. Piotr Suwalski
4. ECMO therapy requires not only the use of expensive equipment, but also a highly specialized medical team. The mere connection of the patient to the device is estimated at approx. 50 thousand. zloty. How much is monthly heart lung therapy?
5. More information on interesting information can be found on the Onet homepage.

“This device saves lives when the lungs are not working”

– We had a patient with COVID-19 who spent nearly 140 days on ECMO. This is a record in Europe and in the world – recently admitted in Gazeta Wyborcza, prof. Piotr Suwalski, head of the cardiac surgery clinic of the Central Clinical Hospital of the Ministry of Interior and Administration. – Unfortunately, a month after the separation, he died. He was breathing on his own, but the degree of lung damage was too great, said the doctor. Most of us heard about ECMO for the first time only in the era of the coronavirus, and most likely in the fall of last year. At that time, the story of 46-year-old Grzegorz Lipiński spread around Poland.

The man was the first patient in our country to have had lungs irreversibly damaged by SARS-CoV-19 transplanted after COVID-2 and probably the first in the world to use ECMO prior to transplantation. Doctors admitted that the man was saved thanks to the implementation of ECMO therapy. But from the beginning.

In the summer, Grzegorz Lipiński was diagnosed with bilateral pneumonia associated with the course of COVID-19. Despite intensive treatment and respiratory support, his condition continued to deteriorate. On the ninth day of hospital stay, the changes already covered 90 percent. pulmonary parenchyma. There was a danger of an embolism. Doctors decided to transport the patient to the University Hospital in Krakow, which had an ECMO device.

1. What Happens to the Lungs After COVID-19? The doctors did not encounter such complications

The patient’s body finally dealt with the coronavirus, although the changes in his lungs were irreversible. The pathogen completely destroyed them, leading to fibrosis, hardening and a significant reduction in this organ. A transplant was necessary. Fortunately, a donor with the correct blood type was found fairly quickly.

The man was saved, among others thanks to the implementation of ECMO therapy. Dr. Konstanty Szułdrzyński from the Krakow hospital compared her to a time machine. – This device saves lives when the lungs are not working, it shifts the burden of gas exchange from the lungs to the extracorporeal technique. This gives time until either the causal treatment takes effect or we replace this organ with a transplant – he explained. This is what happened in the case of Grzegorz Lipiński.

Although many months have passed since then and we can use effective and safe vaccines against COVID-19, ECMO is still proving essential. Moreover, it is more and more often the last resort for young people who, for various reasons, decided not to vaccinate.

ECMO – what is it and how does it help COVID-19 patients?

ECMO (short for Extra Corporeal Membrane Oxygenation) is a technique for extracorporeal blood oxygenation and elimination of carbon dioxide from it. This method can also be used to support circulation. «The ECMO system is an extracorporeal system containing a pump and an oxygenator (artificial heart-lung, i.e. a device used to conduct extracorporeal, temporary gas exchange between blood and air – editor’s note). In short, it can be said that ECMO is a type of prosthesis that replaces the work of the lungs and / or the heart.

ECMO allows you to replace the work of these organs only for a certain period of time – i.e. until their functions improve, allowing for independent work. As we read on ecmo.pl: “the use of this device does not heal a failing organ by itself, but it gives the time needed to recover”. Therefore, the most important criterion for the use of ECMO is the potential reversibility of the process that led to the lung or heart failure.

The time of connection to the ECMO equipment may vary – ranging from a few days to a maximum of several weeks. Why? As we read on ecmo.pl, “with time there are more and more complications related to the chronic use of the extracorporeal system”. It must not be forgotten that the ECMO technique is a very invasive and risky therapy. “It should be weighed against the exhaustion of other treatments.”

The coronavirus pandemic does not spare such situations. For many people infected with SARS-CoV-2, the ECMO system turned out to be the only chance. Scientists from West Virginia University wrote in the spring of last year that this technique can save seriously ill patients with COVID-19 who are no longer helped by a ventilator (because their lungs are damaged). Remember that in severe cases of COVID-19, the greatest threat to life comes from the damage that occurs in the lungs. The blood runs out of oxygen for the brain and other organs.

ECMO also helps in other critical situations, such as after cardiac arrest in deep hypothermia or in the case of severe complications from the flu.

ECMO – what does it look like and how does it work?

The ECMO system has been used for over 30 years. Its prototype was the so-called heart-lung, i.e. apparatus for extracorporeal support for the circulatory system and respiration during cardiac surgery. In Poland, this method was first used in Poland at the Silesian Center for Heart Diseases in Zabrze two decades ago. For a long time it was the only center in the country where it was used. Later, due to the swine flu epidemic, the devices were sent to more hospitals.

Initially, i.e. those several dozen years ago, the device filled the entire hospital room. Today it measures 60 by 40 centimeters and resembles a suitcase with a screen attached to display the patient’s vital signs.

How does the ECMO system work? «The cannula that transports blood is roughly the thickness of a thumb. Blood flow is dependent, inter alia, on on the patient’s weight – it is from 60 to 80 milliliters per kilogram of body weight. When someone weighs, for example, 70 kilograms, 4,5 to 5,5 liters of blood per minute flows through the cannula. Imagine this is half a bucket of blood! If for some reason the cannulae disconnected and the device did not stop, the patient would simply bleed out within a few minutes »- described Dr. Ewa Trejnowska, anesthesiologist at the Silesian Center for Heart Diseases in Zabrze.

The cost of ECMO therapy. 50 thousand for connecting to the device, and this is just the beginning

ECMO therapy is not only associated with frequent complications, it is also very expensive. The price of the camera itself is around 350. zlotys. The mere connection of the patient to the device is valued at 50. PLN – recently announced Gazeta Wyborcza. Unfortunately, this is just the beginning of the expenses.

In addition to expensive equipment, the therapy also requires a highly specialized medical team (doctors, nurses and perfusionists, i.e. specialists handling artificial heart lungs), and the implementation of care tailored to the individual needs of the patient. and cooperation of the entire therapeutic team. – Saving the life of such a seriously ill patient is the success of the entire team »- emphasized Dr. Trejnowska.

“In total, the cost of a month’s treatment – and it is estimated that the therapy of 40-year-olds will last at least before their lungs regenerate – may amount to as much as a million zlotys” – enumerates Gazeta.

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