10 ms·

Covid patients pushed medical extremes in life support breakthrough

96 points by tomhoward 4y ago

neonate 4y ago
https://archive.ph/idtyC https://archive.ph/idtyC
jessriedel 4y ago
Every time I read about ECMO, the stories are saturated with weird comments by doctors and hospital officials about its “proper use”, whether they are doing the right thing to use it, etc. Explicitly they say the concern is for the patient (whether the potential suffering is worth it given the high chance of death), but I can’t square this with the numbers and with other medical practices. Unless there is some extreme physical torture associated with EMCO that’s not mentioned, being on EMCO for a week or month or 6 months seems obviously worth it for a 50% chance of survival from the patient’s perspective. Other patients with different illnesses routinely spend giant amounts of time in the ICU with much slimmer odds. Nothing I read in these articles suggests to me that ECMO stands out unusually above the high background levels of suffering in a modern hospital. I suspect the underlying cause of the handwringing is the immense cost of ECMO (hundreds of thousands of dollars) and the distinct possibility that a patient ends up dependent on it (marginal cost >$5k per day) with no obvious ethical threshold for withdrawing care, at least according to the official prevailing norm that mere cost cannot be a reason to do so. This article is substantially more direct about that: https://khn.org/news/miracle-machine-makes-heroic-rescues-and-leaves-patients-in-limbo/ https://khn.org/news/miracle-machine-makes-heroic-rescues-an... Very interested to hear commentary from people who know more though.
- ceejayoz 4y ago
  Cost isn't the only consideration; staffing is also important. ECMO is extremely high-touch (1:1 nursing recommended, and some patients may need 2:1), even compared to other ICU procedures; given a primary concern during the pandemic was running out of ICU capacity, a bunch of patients on ECMO can cause you to get to that point much more rapidly.
  - JshWright 4y ago
    Staffing is a component of the cost.
    - mrkstu 4y ago
      It’s also an absolute availability issue. A hospital has, in the near to intermediate time horizon, the staff that it has. So dedicating staff in such ratios make them unavailable to other patients, so triage considerations come into play.
    - ceejayoz 4y ago
      Staffing and cost are related, but there are staffing requirements that no amount of money thrown at them can fix.
    - munificent 4y ago
      Nurses are not an infinitely fungible commodity.
      - JshWright 4y ago
        No, but a significant cause of current staffing shortages are stagnant wages (especially for non-travel nursing roles). Hospitals paying decent wages to full-time/permanent staff would go a long way towards solving staffing shortages.
- ausbah 4y ago
  not trying to play doctor here, but a quick skim through the wikipedia article shows a high risk for developing neurological issues, infection, and blood related ailments I imagine, and I hope someone with more knowledge can add on or correct me, that medicinal professionals are generally reluctant to use ECMO for extended periods due to the aforementioned issues. I personally know if my odds of waking up brain dead from a procedure were 50-50%, I wouldn't take that risk. so I wonder if doctors in this case saw a corresponding decrease in such risks? https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation?wprov=sfti1 https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygen...
  - leereeves 4y ago
    I'm not a doctor either, but doesn't chemo have similarly high risks of serious side effects? When the odds of death are close to 100% otherwise, a treatment that improves those odds to 50% doesn't sound so bad.
    - kingkawn 4y ago
      This is a serious decision, not just between 100% death and 50%, but a significantly worse death for the other half of people than the original certain one. Take the final period of a person’s life from them and their family for a devastating treatment that doesn’t help and then see how simple of a choice it feels.
    - JohnBooty 4y ago
      My understanding is that hesitation to employ ECMO isn't about the risk of failure. It's not like chemo or dialysis where you can live some kind of meaningful life while the treatment has an X% chance of buying you Y years. It's extremely labor intensive. Another commenter mentioned 1:1 fulltime nurse care. If true, that means multiple fulltime employees, working in shifts, per ECMO patient. Given finite medical resources (doctors, nurses, beds, ECMO machines) we would like to make sure we're employing this only for patients who have a hope of recovering afterward. In that sense it is similar to other "extreme measures" like ventilators and so on. We can sometimes keep somebody alive in a totally nonviable state for an extended amount of time after heart and/or lung failure, but if there's zero chance for recovery it just doesn't make sense from an ethical or practical standpoint. (edit - when I say "we" I mean society. not "we" as in "we medical professionals." I am not a medical professional!)
- carbocation 4y ago
  ECMO is high risk for the patient, especially venoarterial (VA) ECMO which is probably not what is being described in this article. Venovenous (VV) ECMO doesn't dump blood into the arterial tree, so your risk of stroke or other arterial thrombotic complications is much lower. You still risk infection and venous clotting (and therefore the risks of iatrogenic anticoagulation), but I think most of us would accept those risks. From a systems standpoint, the use of mechanical support usually makes sense in the context of being a bridge to somewhere that is not in-hospital, even in the event of non-recovery. At least where I practice, we want to be able to offer a durable device, or transplantation, if you don't recover. If you live in a place where the health system would not offer transplantation (e.g., because of some risk factor like advanced age), then offering ECMO makes less sense because it is not a bridge to anywhere, particularly for VA ECMO. For VV ECMO, I think there has long been a recognition that people can do OK for an extended period of time (in contrast to VA ECMO, where the risks are higher and there are also destination therapies like ventricular assist devices). And if you're waiting for a lung transplant vs recovery, you may be waiting for quite awhile. To this end, there are special catheters for VV ECMO that facilitate mobility so you can retain some degree of strength and mobility while on ECMO (e.g., https://www.getinge.com/int/product-catalog/avalon-elite-bi-caval-dual-lumen-catheter/ https://www.getinge.com/int/product-catalog/avalon-elite-bi-... ). I'm closer to VA ECMO than to VV ECMO (but do neither); still, your comments ring more true for me about VV ECMO (which again I think is the subject of this article), whereas I think that patient risk + superior bridging/destination strategies really do dominate the VA ECMO discussion.
  - jessriedel 4y ago
    Thank you for this reply. Highly informative. > whereas I think that patient risk + superior bridging/destination strategies really do dominate the VA ECMO discussion. Is the idea here that when doctors are considering VA ECMO for a patient there is usually some non-trivial chance that the patient survives without it? In that case the choice, I guess, is between higher survival with more complications (VV ECMO) and lower survival with fewer complications (no ECMO)?
    - carbocation 4y ago
- kingkawn 4y ago
  The negative side effects are not to be taken lightly, especially if they cause profound suffering prior to a patient’s death or severe lifelong morbidity for a survivor. Yes, there are amazing uses of the technology, but the doctors who refer to proper use are speaking from a place of having seen the improper use.
- andi999 4y ago
  Some countries do not perform hemicorporectomy, since they think survival would not be worth it.
- kxyvr 4y ago
  Outside of the other comments here, I would also suggest considering the expected outcomes rather than just whether or not someone will live and die. For example, if someone spends a month on ECMO and the end result is that they're neurologically devastated, require a feeding tube, tracheostomy, and get discharged to an LTAC, was it worth it? If someone can never have a conversation again, or hold they're children, or read a book, was it worth it? If someone is likely to die, is it worth it to break their ribs or cover them in their own blood and fluid when they code? Given how sick someone is when they're put on ECMO, these are all realistic and likely outcomes. And, look, this is a value choice that families have to make, but also one that most have not considered before getting sick and don't really want to consider when they're thrown into that situation. Physicians know about these likely outcomes, so it affects their opinion about its use. As a brief aside, if anyone does end up in this situation, it's stressful and I'm sorry that you're going through this. Really. If I could offer one unsolicited suggestion, it would be to discuss the possible and likely outcomes with your physician, beyond life and death, so that you can make an informed decision that's best for your family.
  - vkou 4y ago
    Not to mention the costs. Medical resources are limited, and in a country where we are chronically under treating people, it makes no sense to torture someone with an ECMO for a month, only for them to 'recover' to the state mentioned above. That money/medical effort could have been used to save/significantly improve the lives of dozens of people, instead of prolonging the death of one. It all comes out of an insurance pool, it's not like people are bearing ECMO costs out-of-pocket. It all comes out of the same labour pool, when you've got your entire medical staff put on hopeless cases, there are people who could be helped who are being denied treatment.
    - nradov 4y ago
      We are both chronically under treating some patients and over treating others. Over treatment is a leading cause of iatrogenic harm. Some providers default to aggressive treatment whether due to a sincere belief that it's best for the patient, or to satisfy patient requests, or to make more money. But evidence based medicine guidelines indicate that it's often best to do nothing beyond active monitoring of the patient's condition. https://dx.doi.org/10.1371%2Fjournal.pone.0181970 https://dx.doi.org/10.1371%2Fjournal.pone.0181970 Ideally we should be allocating limited medical resources based on formulas that maximize overall benefit as quantified by quality-adjusted life years (QALY). But it's politically difficult to set rational policies around rationing care without triggering toxic disputes about "death panels" and "killing grandma".
- meroes 4y ago
  What do the survivors deal with though? I recently had an injury that required surgery and occupational therapy. My entire limb was a sad, useless appendage for months mostly due to immobility and how it reacted to pain. I can’t imagine the mountain one must surmount to get back to even 25% of their pre illness self. I was down to 15% use by the time my OT started. And 6 months later it still is a daily task to keep improving (much better now though). It must take an incredible toll and on already sick body.
- cat_plus_plus 4y ago
  I think the right thing to do for the time being is to consider prolonged use of ECMO as a research practice where not everyone is accepted but those accepted taken care off as long as they are conscious or have a decent chance of regaining consciousness and making their own informed decision. Costs of doing so are part of research budget that determines how many patients can be included. Not providing care to everyone is ethical so long as we don't know if the care is going to help anyway. In turn, research can determine - Exactly what kind of patients are most likely to recover after prolonged use of current ECMO machines - Potential ways to bring equipment and nursing costs down while preserving most of effectiveness. - Ways to wean the patient off intensive care long term. For example, the very first genetically modified pig heart transplant resulted in 2 months conscious survival. Even if animal transplants never become a long term solution, they could prove more cost and medically effective than ECMOs to buy time for own organ recovery or a human transplant.
- Fomite 4y ago
  A lot of my infection control colleagues are rightly terrified of keeping people on ECMO or mechanical ventilation due to infection risk, that are extremely hard to treat. This was especially acute during the early phase of the pandemic, when the combination of the intensity of care COVID patients required + the PPE shortage meant some compromises that they'd really prefer not to make.
spacexsucks 4y ago
Side note: I get this ------ Potential automated action detected! Newscorp Australia are trialling new security software on our mastheads. If you receive "Potential automated action detected!" please try these steps first: Temporarily disable any AdBlockers / pop-up blockers / script blockers you have enabled Add this site in to the allowed list for any AdBlockers / pop-up blockers / script blockers you have enabled Ensure your browser supports JavaScript (this can be done via accessing https://www.whatismybrowser.com/detect/is-javascript-enabled https://www.whatismybrowser.com/detect/is-javascript-enabled in your browser) Ensure you are using the latest version of your web browser If you need to be unblocked please e-mail us at accessissues@news.com.au and provide the IP address and reference number shown here along with why you require access. News Corp Australia. Your IP address is: xxxxx | Your reference number is: 0.dda0760.1651235940.34576953 ----- You know I dont want your content herald.
- jeroenhd 4y ago
  Wow, that's pretty terrible. You can use archive links (https://archive.ph/idtyC https://archive.ph/idtyC) if you care enough but the way this website treats visitors made me lose interest in the story all together. If I click the link om redirected to some subdomein that's blocked by my PiHole so that's also quite telling.
sonicggg 4y ago
If you are bad enough to need ECMO, you may as well wish you were dead. Not sure what is better. Little is talked about the life of these people after they are "saved", whatever that word means. Besides sequelae from Covid itself, you're getting ECMO sequelae as a cherry on top. You can't just go back to life as it was.
- rob74 4y ago
  Not just ECMO, people who were "only" on a respirator for a few weeks/months also have their fair share of issues afterwards. Makes you think reading stories like these should be enough to convince anyone to get vaccinated. But some people are still convinced that this won't happen to them if they get Covid, however they fear any number of side effects from the vaccination...
  - azinman2 4y ago
    Just go read the sister thread right now on myocarditis in Israel… people are calling for tribunals on medical malpractice for forcing people to get vaccines…
    - DontMindit 4y ago
      Can you link the thread please. I looked through your profiles other comments but I didn't see it.
      - nradov 4y ago
        I don't know if there is a discussion thread but an Israeli study was just published yesterday which found an association between COVID-19 vaccination and myocarditis in young men. https://doi.org/10.1038/s41598-022-10928-z https://doi.org/10.1038/s41598-022-10928-z (I am not taking a position on the findings of that study, just providing a link as a reference.)
      - somenameforme 4y ago
        Not the person you're responding to, but if you're unaware/interested in relevant data this study [1] was just published 10 days ago and it's interesting. It compared the rates of myocarditis/pericarditis only within the 28 day period following vaccination to the rates experienced by unvaccinated individuals over a sample of 23 million Europeans. Keep in mind the metric they use (IRR - incident rate ratio) is a ratio, not a percent. So an IRR of 15 means 1500% more events. Table 2 lays out everything quite nicely. To see it you need to click on figures/tables and scroll down a bit. [1] - https://jamanetwork.com/journals/jamacardiology/fullarticle/2791253 https://jamanetwork.com/journals/jamacardiology/fullarticle/...
unwind 4y ago
Completely unreadable for me due to three hovering ads, along three edges of the screen. Easily the worst experience I can remember seeing.
chiefalchemist 4y ago
Ok. But at what cost? Not financial cost per se, but along the lines of opportunity cost. These efforts, while very impressive, consume a significant (read: disproportionate) amount of resources. Resources that could possibly be deployed elsewhere. I'm not suggesting it was foolish to do this. But there is broader context for "do no harm".
abathur 4y ago
As a counterpoint (anecdata...) to some comments here... After contracting covid around Christmas and ~recovering over about 2 weeks, one of my younger sisters, 31 + pregnant, started feeling short of breath in late February. She went into the hospital, was held for observation/testing for a little over a day but was in good spirits. Healthy. No major preexisting conditions before covid (aside from pregnancy and some allergies). No ~ground-glass anomaly (as I understand it). She went into acute respiratory distress in the wee hours of the morning. Intubation helped get oxygen in, but C02 was building in her blood. Within 4 hours, they made the call to put her on ECMO. They needed to wheel her to another wing of the hospital and told her husband she might not even last that long. The chaplain followed them over. Once there, they sprayed the walls and bed with her blood, and made her a cyborg for a week. And then we got her back. (Well. Kinda. She was diagnosed with pre-eclampsia during this episode, and is having to live in the hospital until she delivers.) She is, demographically, the kind of patient that merits interventions like this. As the news filtered to me several hundred miles away in spurts and haunting silences, I started my grieving when I heard she'd been intubated. ECMO was the only light in the tunnel. (* I write this as a selfish brother with zero knowledge of the long term financial consequences to my sister and her young family.)
- chinathrow 4y ago
  Wow, that was hard to read. Was she vaccinated against Covid?
  - psychlops 4y ago
    Out of curiosity, of what will the answer inform you?
    - barrkel 4y ago
      If she was vaccinated, then COVID sounds like it could still be a big problem. If not, then the current general impression of COVID largely being behind us (us being the vaccinated world) is still tenable.
patchtopic 4y ago
old Melbourne saying: "Is it the truth, or did you read it in the Herald Sun?".. like any Murdoch rag it sometimes might put out a news article to keep up appearances, but there is usually a better source..

96 points by tomhoward 4y ago

https://archive.ph/idtyC https://archive.ph/idtyC

Every time I read about ECMO, the stories are saturated with weird comments by doctors and hospital officials about its “proper use”, whether they are doing the right thing to use it, etc. Explicitly they say the concern is for the patient (whether the potential suffering is worth it given the high chance of death), but I can’t square this with the numbers and with other medical practices. Unless there is some extreme physical torture associated with EMCO that’s not mentioned, being on EMCO for a week or month or 6 months seems obviously worth it for a 50% chance of survival from the patient’s perspective. Other patients with different illnesses routinely spend giant amounts of time in the ICU with much slimmer odds. Nothing I read in these articles suggests to me that ECMO stands out unusually above the high background levels of suffering in a modern hospital. I suspect the underlying cause of the handwringing is the immense cost of ECMO (hundreds of thousands of dollars) and the distinct possibility that a patient ends up dependent on it (marginal cost >$5k per day) with no obvious ethical threshold for withdrawing care, at least according to the official prevailing norm that mere cost cannot be a reason to do so. This article is substantially more direct about that: https://khn.org/news/miracle-machine-makes-heroic-rescues-and-leaves-patients-in-limbo/ https://khn.org/news/miracle-machine-makes-heroic-rescues-an... Very interested to hear commentary from people who know more though.

ceejayoz 4y ago
Cost isn't the only consideration; staffing is also important. ECMO is extremely high-touch (1:1 nursing recommended, and some patients may need 2:1), even compared to other ICU procedures; given a primary concern during the pandemic was running out of ICU capacity, a bunch of patients on ECMO can cause you to get to that point much more rapidly.
- JshWright 4y ago
  Staffing is a component of the cost.
  - mrkstu 4y ago
    It’s also an absolute availability issue. A hospital has, in the near to intermediate time horizon, the staff that it has. So dedicating staff in such ratios make them unavailable to other patients, so triage considerations come into play.
  - ceejayoz 4y ago
    Staffing and cost are related, but there are staffing requirements that no amount of money thrown at them can fix.
  - munificent 4y ago
    Nurses are not an infinitely fungible commodity.
    - JshWright 4y ago
      No, but a significant cause of current staffing shortages are stagnant wages (especially for non-travel nursing roles). Hospitals paying decent wages to full-time/permanent staff would go a long way towards solving staffing shortages.
ausbah 4y ago
not trying to play doctor here, but a quick skim through the wikipedia article shows a high risk for developing neurological issues, infection, and blood related ailments I imagine, and I hope someone with more knowledge can add on or correct me, that medicinal professionals are generally reluctant to use ECMO for extended periods due to the aforementioned issues. I personally know if my odds of waking up brain dead from a procedure were 50-50%, I wouldn't take that risk. so I wonder if doctors in this case saw a corresponding decrease in such risks? https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation?wprov=sfti1 https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygen...
- leereeves 4y ago
  I'm not a doctor either, but doesn't chemo have similarly high risks of serious side effects? When the odds of death are close to 100% otherwise, a treatment that improves those odds to 50% doesn't sound so bad.
  - kingkawn 4y ago
    This is a serious decision, not just between 100% death and 50%, but a significantly worse death for the other half of people than the original certain one. Take the final period of a person’s life from them and their family for a devastating treatment that doesn’t help and then see how simple of a choice it feels.
  - JohnBooty 4y ago
    My understanding is that hesitation to employ ECMO isn't about the risk of failure. It's not like chemo or dialysis where you can live some kind of meaningful life while the treatment has an X% chance of buying you Y years. It's extremely labor intensive. Another commenter mentioned 1:1 fulltime nurse care. If true, that means multiple fulltime employees, working in shifts, per ECMO patient. Given finite medical resources (doctors, nurses, beds, ECMO machines) we would like to make sure we're employing this only for patients who have a hope of recovering afterward. In that sense it is similar to other "extreme measures" like ventilators and so on. We can sometimes keep somebody alive in a totally nonviable state for an extended amount of time after heart and/or lung failure, but if there's zero chance for recovery it just doesn't make sense from an ethical or practical standpoint. (edit - when I say "we" I mean society. not "we" as in "we medical professionals." I am not a medical professional!)
carbocation 4y ago
ECMO is high risk for the patient, especially venoarterial (VA) ECMO which is probably not what is being described in this article. Venovenous (VV) ECMO doesn't dump blood into the arterial tree, so your risk of stroke or other arterial thrombotic complications is much lower. You still risk infection and venous clotting (and therefore the risks of iatrogenic anticoagulation), but I think most of us would accept those risks. From a systems standpoint, the use of mechanical support usually makes sense in the context of being a bridge to somewhere that is not in-hospital, even in the event of non-recovery. At least where I practice, we want to be able to offer a durable device, or transplantation, if you don't recover. If you live in a place where the health system would not offer transplantation (e.g., because of some risk factor like advanced age), then offering ECMO makes less sense because it is not a bridge to anywhere, particularly for VA ECMO. For VV ECMO, I think there has long been a recognition that people can do OK for an extended period of time (in contrast to VA ECMO, where the risks are higher and there are also destination therapies like ventricular assist devices). And if you're waiting for a lung transplant vs recovery, you may be waiting for quite awhile. To this end, there are special catheters for VV ECMO that facilitate mobility so you can retain some degree of strength and mobility while on ECMO (e.g., https://www.getinge.com/int/product-catalog/avalon-elite-bi-caval-dual-lumen-catheter/ https://www.getinge.com/int/product-catalog/avalon-elite-bi-... ). I'm closer to VA ECMO than to VV ECMO (but do neither); still, your comments ring more true for me about VV ECMO (which again I think is the subject of this article), whereas I think that patient risk + superior bridging/destination strategies really do dominate the VA ECMO discussion.
- jessriedel 4y ago
  Thank you for this reply. Highly informative. > whereas I think that patient risk + superior bridging/destination strategies really do dominate the VA ECMO discussion. Is the idea here that when doctors are considering VA ECMO for a patient there is usually some non-trivial chance that the patient survives without it? In that case the choice, I guess, is between higher survival with more complications (VV ECMO) and lower survival with fewer complications (no ECMO)?
  - carbocation 4y ago
kingkawn 4y ago
The negative side effects are not to be taken lightly, especially if they cause profound suffering prior to a patient’s death or severe lifelong morbidity for a survivor. Yes, there are amazing uses of the technology, but the doctors who refer to proper use are speaking from a place of having seen the improper use.
andi999 4y ago
Some countries do not perform hemicorporectomy, since they think survival would not be worth it.
kxyvr 4y ago
Outside of the other comments here, I would also suggest considering the expected outcomes rather than just whether or not someone will live and die. For example, if someone spends a month on ECMO and the end result is that they're neurologically devastated, require a feeding tube, tracheostomy, and get discharged to an LTAC, was it worth it? If someone can never have a conversation again, or hold they're children, or read a book, was it worth it? If someone is likely to die, is it worth it to break their ribs or cover them in their own blood and fluid when they code? Given how sick someone is when they're put on ECMO, these are all realistic and likely outcomes. And, look, this is a value choice that families have to make, but also one that most have not considered before getting sick and don't really want to consider when they're thrown into that situation. Physicians know about these likely outcomes, so it affects their opinion about its use. As a brief aside, if anyone does end up in this situation, it's stressful and I'm sorry that you're going through this. Really. If I could offer one unsolicited suggestion, it would be to discuss the possible and likely outcomes with your physician, beyond life and death, so that you can make an informed decision that's best for your family.
- vkou 4y ago
  Not to mention the costs. Medical resources are limited, and in a country where we are chronically under treating people, it makes no sense to torture someone with an ECMO for a month, only for them to 'recover' to the state mentioned above. That money/medical effort could have been used to save/significantly improve the lives of dozens of people, instead of prolonging the death of one. It all comes out of an insurance pool, it's not like people are bearing ECMO costs out-of-pocket. It all comes out of the same labour pool, when you've got your entire medical staff put on hopeless cases, there are people who could be helped who are being denied treatment.
  - nradov 4y ago
    We are both chronically under treating some patients and over treating others. Over treatment is a leading cause of iatrogenic harm. Some providers default to aggressive treatment whether due to a sincere belief that it's best for the patient, or to satisfy patient requests, or to make more money. But evidence based medicine guidelines indicate that it's often best to do nothing beyond active monitoring of the patient's condition. https://dx.doi.org/10.1371%2Fjournal.pone.0181970 https://dx.doi.org/10.1371%2Fjournal.pone.0181970 Ideally we should be allocating limited medical resources based on formulas that maximize overall benefit as quantified by quality-adjusted life years (QALY). But it's politically difficult to set rational policies around rationing care without triggering toxic disputes about "death panels" and "killing grandma".
meroes 4y ago
What do the survivors deal with though? I recently had an injury that required surgery and occupational therapy. My entire limb was a sad, useless appendage for months mostly due to immobility and how it reacted to pain. I can’t imagine the mountain one must surmount to get back to even 25% of their pre illness self. I was down to 15% use by the time my OT started. And 6 months later it still is a daily task to keep improving (much better now though). It must take an incredible toll and on already sick body.
cat_plus_plus 4y ago
I think the right thing to do for the time being is to consider prolonged use of ECMO as a research practice where not everyone is accepted but those accepted taken care off as long as they are conscious or have a decent chance of regaining consciousness and making their own informed decision. Costs of doing so are part of research budget that determines how many patients can be included. Not providing care to everyone is ethical so long as we don't know if the care is going to help anyway. In turn, research can determine - Exactly what kind of patients are most likely to recover after prolonged use of current ECMO machines - Potential ways to bring equipment and nursing costs down while preserving most of effectiveness. - Ways to wean the patient off intensive care long term. For example, the very first genetically modified pig heart transplant resulted in 2 months conscious survival. Even if animal transplants never become a long term solution, they could prove more cost and medically effective than ECMOs to buy time for own organ recovery or a human transplant.
Fomite 4y ago
A lot of my infection control colleagues are rightly terrified of keeping people on ECMO or mechanical ventilation due to infection risk, that are extremely hard to treat. This was especially acute during the early phase of the pandemic, when the combination of the intensity of care COVID patients required + the PPE shortage meant some compromises that they'd really prefer not to make.

spacexsucks 4y ago

Side note: I get this ------ Potential automated action detected! Newscorp Australia are trialling new security software on our mastheads. If you receive "Potential automated action detected!" please try these steps first: Temporarily disable any AdBlockers / pop-up blockers / script blockers you have enabled Add this site in to the allowed list for any AdBlockers / pop-up blockers / script blockers you have enabled Ensure your browser supports JavaScript (this can be done via accessing https://www.whatismybrowser.com/detect/is-javascript-enabled https://www.whatismybrowser.com/detect/is-javascript-enabled in your browser) Ensure you are using the latest version of your web browser If you need to be unblocked please e-mail us at accessissues@news.com.au and provide the IP address and reference number shown here along with why you require access. News Corp Australia. Your IP address is: xxxxx | Your reference number is: 0.dda0760.1651235940.34576953 ----- You know I dont want your content herald.

jeroenhd 4y ago
Wow, that's pretty terrible. You can use archive links (https://archive.ph/idtyC https://archive.ph/idtyC) if you care enough but the way this website treats visitors made me lose interest in the story all together. If I click the link om redirected to some subdomein that's blocked by my PiHole so that's also quite telling.

sonicggg 4y ago

If you are bad enough to need ECMO, you may as well wish you were dead. Not sure what is better. Little is talked about the life of these people after they are "saved", whatever that word means. Besides sequelae from Covid itself, you're getting ECMO sequelae as a cherry on top. You can't just go back to life as it was.

rob74 4y ago
Not just ECMO, people who were "only" on a respirator for a few weeks/months also have their fair share of issues afterwards. Makes you think reading stories like these should be enough to convince anyone to get vaccinated. But some people are still convinced that this won't happen to them if they get Covid, however they fear any number of side effects from the vaccination...
- azinman2 4y ago
  Just go read the sister thread right now on myocarditis in Israel… people are calling for tribunals on medical malpractice for forcing people to get vaccines…
  - DontMindit 4y ago
    Can you link the thread please. I looked through your profiles other comments but I didn't see it.
    - nradov 4y ago
      I don't know if there is a discussion thread but an Israeli study was just published yesterday which found an association between COVID-19 vaccination and myocarditis in young men. https://doi.org/10.1038/s41598-022-10928-z https://doi.org/10.1038/s41598-022-10928-z (I am not taking a position on the findings of that study, just providing a link as a reference.)
    - somenameforme 4y ago
      Not the person you're responding to, but if you're unaware/interested in relevant data this study [1] was just published 10 days ago and it's interesting. It compared the rates of myocarditis/pericarditis only within the 28 day period following vaccination to the rates experienced by unvaccinated individuals over a sample of 23 million Europeans. Keep in mind the metric they use (IRR - incident rate ratio) is a ratio, not a percent. So an IRR of 15 means 1500% more events. Table 2 lays out everything quite nicely. To see it you need to click on figures/tables and scroll down a bit. [1] - https://jamanetwork.com/journals/jamacardiology/fullarticle/2791253 https://jamanetwork.com/journals/jamacardiology/fullarticle/...

unwind 4y ago

Completely unreadable for me due to three hovering ads, along three edges of the screen. Easily the worst experience I can remember seeing.

chiefalchemist 4y ago

Ok. But at what cost? Not financial cost per se, but along the lines of opportunity cost. These efforts, while very impressive, consume a significant (read: disproportionate) amount of resources. Resources that could possibly be deployed elsewhere. I'm not suggesting it was foolish to do this. But there is broader context for "do no harm".

abathur 4y ago

As a counterpoint (anecdata...) to some comments here... After contracting covid around Christmas and ~recovering over about 2 weeks, one of my younger sisters, 31 + pregnant, started feeling short of breath in late February. She went into the hospital, was held for observation/testing for a little over a day but was in good spirits. Healthy. No major preexisting conditions before covid (aside from pregnancy and some allergies). No ~ground-glass anomaly (as I understand it). She went into acute respiratory distress in the wee hours of the morning. Intubation helped get oxygen in, but C02 was building in her blood. Within 4 hours, they made the call to put her on ECMO. They needed to wheel her to another wing of the hospital and told her husband she might not even last that long. The chaplain followed them over. Once there, they sprayed the walls and bed with her blood, and made her a cyborg for a week. And then we got her back. (Well. Kinda. She was diagnosed with pre-eclampsia during this episode, and is having to live in the hospital until she delivers.) She is, demographically, the kind of patient that merits interventions like this. As the news filtered to me several hundred miles away in spurts and haunting silences, I started my grieving when I heard she'd been intubated. ECMO was the only light in the tunnel. (* I write this as a selfish brother with zero knowledge of the long term financial consequences to my sister and her young family.)

chinathrow 4y ago
Wow, that was hard to read. Was she vaccinated against Covid?
- psychlops 4y ago
  Out of curiosity, of what will the answer inform you?
  - barrkel 4y ago
    If she was vaccinated, then COVID sounds like it could still be a big problem. If not, then the current general impression of COVID largely being behind us (us being the vaccinated world) is still tenable.

patchtopic 4y ago

old Melbourne saying: "Is it the truth, or did you read it in the Herald Sun?".. like any Murdoch rag it sometimes might put out a news article to keep up appearances, but there is usually a better source..