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$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. Gener

$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 ago
Just 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 ago
It'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
- petschge 7y ago
  ECMO is not sustainable for long. The extra mechanical stress on the platelets and all the precautions you have to take against blood clots forming on any off the artificial surfaces are rather damaging. And since it is an expensive, short-term-only intervention there is no need for it to be particularly mobile. For the few days to weeks you are on ECMO while quite seriously ill, the ICU is the best place for you. 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.
  - fiter 7y ago
    Are you saying those details cannot be resolved or are you just talking about ECMO as it exists today?
    - petschge 7y ago
      Most of those problems have been considered unsolvable for a long time. Recent advanced in artificial hearts and heart assist devices (LVADs) have shown that at least a small fraction of the problems can be solved. For the rest? I'm not even sure if we know if they are solvable or not.

joney_baloney 7y ago

Just 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 ago

It'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

petschge 7y ago
ECMO is not sustainable for long. The extra mechanical stress on the platelets and all the precautions you have to take against blood clots forming on any off the artificial surfaces are rather damaging. And since it is an expensive, short-term-only intervention there is no need for it to be particularly mobile. For the few days to weeks you are on ECMO while quite seriously ill, the ICU is the best place for you. 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.
- fiter 7y ago
  Are you saying those details cannot be resolved or are you just talking about ECMO as it exists today?
  - petschge 7y ago
    Most of those problems have been considered unsolvable for a long time. Recent advanced in artificial hearts and heart assist devices (LVADs) have shown that at least a small fraction of the problems can be solved. For the rest? I'm not even sure if we know if they are solvable or not.