11 ms·
ECMO pumps blood out of the body, oxygenates it and returns it to the body
- legohead 7y agoYou can always build more ECMOs. I imagine the technology will get more advanced too, eventually portable. Turning it off for lucid users doesn't seem like an appropriate choice.
- jandrese 7y ago> hospital charged $4.2 million for a 60-day ECMO Almost $3,000 an hour!
- zrail 7y agoNot only is it a bed in one of the most expensive units in a hospital, typically at a level 1 trauma center, but it’s also incredibly labor intensive. Round the clock personal care by at least one nurse.
- jandrese 7y agoThe nurse's salary is probably less than $50/hour[1]. It's a small fraction of the cost for operating this machine. [1] https://nurse.org/articles/highest-paying-states-for-registered-nurses/ https://nurse.org/articles/highest-paying-states-for-registe...
- walshemj 7y agoI would expect that a lot of the nurses in these sort of units are the higher paid grades.
- khuey 7y agoEven if the nurse is billed out at $500 an hour you're still only 1/6th of the way to that price.
- walshemj 7y agoA senior nurse plus all the supporting staff there will also be the on duty doctors. 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
- biofox 7y agoAccording to this BBC article, the average cost of ECMO treatment in the UK is £45,000 per patient: https://www.bbc.co.uk/news/uk-wales-45409281 https://www.bbc.co.uk/news/uk-wales-45409281 Medical care in the US is seriously broken.
- skissane 7y ago> According to this BBC article, the average cost of ECMO treatment in the UK is £45,000 per patient: 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)
- lsaferite 7y agoFor our daughter, there was a technician that literally sat next to the machine 24/7. There was never one moment without a technician there. Then there were all the other staff tending to her. The x-ray techs (2x daily x-rays), the respiratory techs, doctors, tons of other equipment and medicines. Our bill was just north of 600k for 10 days on ECMO, medevac, and 4 days in the NICU2 on a respirator.
- lsaferite 7y agoThat's roughly $1800/hr for the stay I think
- mikelyons 7y agoIn the future there'll be giant pipes of blood routed around the world that are transparent and glow bright red or dark crimson, the arteries and veins of the planet's Humanity Support System 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.
- yladiz 7y agoWhat?
- shawnz 7y agoYou might be interested in Greg Egan's book Diaspora, which shows a view of a possible future in which we are able to upload our brains to computers.
- snazz 7y agoDisregarding ethical concerns, how challenging would it be to artificially provide signals to nerves going to the brain and get output through other nerves? With some kind of device like an ECMO connected directly to an extracted brain, the optical nerves connected to a computer somehow, and some fine motor control nerves connected back to the computer, a brain could operate completely outside of a body.
- deleted 7y ago[deleted]
- kitrose 7y agoMy wife is a perfusionist (specialist who runs these pumps and similar ones while the heart is being operated on). ECMO’s really an incredible feat of medicine that can bring people back from the edge where they would otherwise die.
- Jare 7y agoMy son spent 10 of his first 15 days of life plugged to an ECMO (he's 5 years old now!). Through the pain, fear and despair of 3 failed attempts to get him out of it, one of the thoughts that my head clung to for sanity was exactly what you describe, that awe of what the machine's power, and awe at the amazing people who, like your wife, tended to it and to my son.
- kitrose 7y agoGlad to hear your son is doing well. I can barely imagine how difficult those 2 weeks must have been.
- lsaferite 7y agoMy daughter spent her first 10 days of life on ECMO. She had severe Meconium Aspiration Syndrome (MAS) and mild Patent Ductus Arteriosus (PDA). She's a happy and healthy 6 y/o now. It was terrifying to watch them try to keep her alive for 4 hours in NICU2 the hospital where she was born. They eventually gave up and medevaced her to a hospital with a NICU3. Once she went on ECMO we had hope she might actually survive. ECMO is amazing.
- xwdv 7y agoWow, so a person could really be as extremely lucid and awake as you are now, but hooked up to an ECMO, knowing that there’s no hope and with one flick of the switch it’s all over?
- whatshisface 7y agoIf it happened to someone like Bill Gates, maybe they'd decide to stay on it until somebody invented a portable version. Another interesting thought is that if the price of this thing falls a bit, there might be a few high-power professionals and executives who make more in an hour than the future ECMO costs to run. It doesn't look that big, maybe before long there will be a billionaire that travels around with a personal perfusionist wheeling an ECMO unit behind them. After that millionaires will start doing it, and in the end there will be affordable and entirely artificial respiratory systems.
- albertgoeswoof 7y agoYou think someone on ECMO is going to work? 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.
- whatshisface 7y agoThe article said a teenager did his homework while on one.
- pryce 7y agoAnd if he decided not to do it, no one would mind. I say this as someone who has worked (briefly) in ICU, as well as having volunteered in a hospital school for two years, and (unfortunately) have had my own teenager in the ICU. 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?
- stupidcar 7y agoWhile I can understand the disquiet about loading patients onto this device when it's a bridge to nowhere, in terms of treatment and recovery, wouldn't it better to look at this in a more positive way: As providing the necessary (and astonishing, technologically speaking) first step in being able to treat previously untreatable conditions. 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.
- kitrose 7y agoFrom a layman’s perspective, what I often hear ECMO being used for is to allow the heart/lungs recover for a while from the sheer trauma of a heart attack or surgery while not bearing any critical load.
- EnFinlay 7y agoHow the technology is viewed isn't the question, the question is how to most ethically administer this technology at the moment, with the medical interventions that are possible/reasonable.
- rscho 7y agoWhile it's clear ECMO is useful and sometimes lifesaving, I feel its constraints are underappreciated by the layman. Being on pump in itself is a major inflammatory trigger and is really, really not a walk in the park. 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.
- ChuckMcM 7y agoFascinating, if somewhat depressing[1] read. 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.
- fao_ 7y agoI can guarantee, if you can provide the entire body's function in a wheelchair, you can slap arms on that had have them movable by a person. We're talking at current level of tech.
- ChuckMcM 7y agoAbsolutely, and have them move by brainwaves. It was one of the more amusing things that Star Trek didn't go far enough to be the future (like they can't cure male pattern baldness but give someone a pill and they grow a new kidney) but science continuity aside. Where does that leave us with an ethical obligation to people who are alive but not alive. Imagine if Pike got Alzheimers, when would Starfleet pull the plug on him? It is an ethically challenging place.
- deathanatos 7y ago> At a press conference about Star Trek: The Next Generation, a reporter asked Star Trek creator Gene Roddenberry about casting Patrick Stewart, commenting that "Surely by the 24th century, they would have found a cure for male pattern baldness." Gene Roddenberry had the perfect response. > "No, by the 24th century, no one will care." https://boingboing.net/2015/07/08/star-trek-creators-perfect-c.html https://boingboing.net/2015/07/08/star-trek-creators-perfect...
- Scoundreller 7y agoHow many years until I can swim in the sea/ocean without a mask?
- shoes_for_thee 7y agoYou can do that now.
- teraflop 7y agoThe solubility of oxygen in water just isn't high enough to make it practical to extract enough oxygen for breathing. You would need something like 50 gallons per minute just to satisfy your basic resting metabolism, which in turn would require a ton of power and/or surface area for gas exchange. (Multiply that by a factor of 3 or 4 if you intend to actually do any swimming.) 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.
- forgotpwagain 7y agoThe stories in this piece really highlight the importance of having these tough conversations with family members about what you want to happen for your own medical care if the worst happened. 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.
- alleycat5000 7y agoReminded me of this excellent read, https://en.m.wikipedia.org/wiki/Being_Mortal https://en.m.wikipedia.org/wiki/Being_Mortal
- chancla35 7y ago$0.02 from a doctor who has cared for ECMO patients in the ICU, and delivered anesthesia for multiple open heart surgeries and heart +/- lung transplants. Generally speaking, patients on ECMO tend to do well if (and only if) they need ECMO due to a reversible cause. Examples include prematurity (kids will grow up), a particularly virulent strain of the flu in a child or young adult (I believe the OP falls into this camp), and open heart surgery. There's also some evidence to support the use of ECMO for a very short period of time in the setting of some acute strokes. 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
- joney_baloney 7y agoJust want to say thank you for what you do. I spent a few days on ECMO in 2005 during the course of a double lung tx and saw some true heroics from the folks keeping me alive. It was a hell of an experience.
- fiter 7y agoIt's not clear to me why it would be a fool's errand to make it more portable, cheaper, etc. 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. [0] https://amhistory.si.edu/polio/howpolio/ironlung.htm https://amhistory.si.edu/polio/howpolio/ironlung.htm
- deleted 7y ago[deleted]
- zepto 7y agoA billionaire could use this to remain alive for decades after they would otherwise have died - long enough for cloned organs to be grown to replace the ones that are failing.
- lsaferite 7y agoEvery day on ECMO is a roll of dice. There is a severe risk of clots. They could cause arterial blockages and strokes. They have to put you on blood thinners to combat the clots. The blood thinners could cause brain bleeds. There's also the risk of infections and the constant feed of antibiotics to combat that. ECMO, at least as it is right now, isn't meant to be a long term solution. As they said in the article, it's merely meant to be a bridge. Edit: that's roughly $1800/hr for the stay I think
- drpgq 7y agoThis seems like a future Black Mirror episode.
- inflatableDodo 7y agoHas anyone who is conscious and going to get the plug pulled tried to kidnap a nurse and sneak out with the ECMO yet? 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.
- seriocomic 7y agoI'm alive now because of this machine/technology (well, maybe the truth more lies in the fact that I was geographically close to where an ECMO machine was available when I fell ill). 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 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.
- deleted 7y ago[deleted]
- SubiculumCode 7y agoThank you for sharing. I am glad you made it through that. 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.
- Choco31415 7y agoFrom his's wife's diary, it was necessary because the insertion site for the original was not working as expected: "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."
- PHGamer 7y agowell yea it sucks right now but thats true for your body. literally if someone turns the switch to your heart off your fucked. its just harder to carry around an ecmo machine ;-). I hope we get artificial hearts some day. but oh well.
- throwaway78145 7y agoMy son, born two weeks late needed ECMO and was on it for a span of a week in 2005. He was septic due to a severe case of Meconium aspiration and unable to breathe even with the most aggressive ventilator (and as the doctors informed me, it would likely damage his lungs pretty badly as the pressure required to get him to proper levels of oxygen in the bloodstream were pretty rough) Today he is perfectly fine (in fact a cross country runner), and I of course thank that machine. It is an amazing machine. Which reminds me, it's probably time to give blood!
- throwaway1239jj 7y agoSame story here. 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!
- iancmceachern 7y agoFull disclosure- I design medical devices like these, including many blood pumps and an ecmo device or two. 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...
- pcj-github 7y agoAs a former vascular surgeon and having worked with this directly, ECMO is definitely an amazing lifesaving medical technology if used appropriately. Unfortunately there is a perverse incentive to have more ECMO patients as they can generate huge insurance bills. So, the hospital loves it if the patient attached to it has insurance (and hates it otherwise).
- devilmoon 7y agoMy mom is alive thanks to this machine! 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
- wonnage 7y agoAssuming the patients were covered by insurance it's unlikely they paid anywhere near that amount. Those were the hospital's costs.
- jessriedel 7y agoIt's very unlikely they would pay anywhere near that amount if they weren't covered by insurance either.
- Aromasin 7y agoHowever, under a socialized healthcare system it's completely unlikely they would pay anything at all. That distinction probably saves lives on stress-relief alone.
- 7y ago
- alister 7y agoWhat's not explained is the difference between this latest miracle machine called ECMO and the plain old heart–lung machines (aka cardiopulmonary bypass or CPB) which I'm confident that most people have heard of. Note that heart–lung machines oxygenate blood just like ECMO. As far as I can tell, heart–lung machines are used only during surgery whereas ECMO seems to serve exactly the same function but comes in self-contained packaging so it can be used longer term outside of surgery. Could someone with more domain knowledge tell us if ECMO really is an entirely new paradigm like the article claims?
- alexgmcm 7y agoThis combined with the recent BrainEx paper[1] makes me wonder how far away we are from "Brain in a box" style immortality. [1] https://www.nature.com/articles/d41586-019-01216-4 https://www.nature.com/articles/d41586-019-01216-4
- vegardx 7y agoA couple of years ago such a machine was transported between two hospitals in Trondheim and Bodø (450km), using a F-16 fighter jet. It all started with a phone call from a doctor at St. Olavs Hospital with what he described as an unusual request for assistance. 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.