4 ms·

Not to downplay the dilemmas we face today, it seems to me that the main problem is that the machine is too expensive, too complicated and too large to serve a

by drxzcl 2y ago

Not to downplay the dilemmas we face today, it seems to me that the main problem is that the machine is too expensive, too complicated and too large to serve as a permanent heart/lung replacement. We have an excellent record of making machines smaller, cheaper and simpler to operate. This machine will be the pacemaker of the future.

sxg 2y ago
That's definitely not the main problem. Risk of intracranial hemorrhage/strokes and other complications make it problematic.
- saurik 2y ago
  But that isn't the problem from the article--the ethical issue of how to deal with a ton of people who are being kept alive on a "bridge to nowhere" when the machines might could be used in the interim to save many more people--as if you have an intracranial hemorrhage you are going to start down the road to actually dying. (And the article also talks about attempts to improve the bleeding problem anyway.)
  - toth 2y ago
    To me it sounded like part of the problem is that people on ECMO cannot leave the ICU because at any moment they might have a complication that requires immediate emergency care. So it's not enough to make them smaller and cheaper, they also have to be made much less prone to these complications. I am sure that will happen in time, but I am also sure we'll be able to grow people new lungs in time
    - FireBeyond 2y ago
      Critical care paramedic: that's very much the bigger issue. Some life flight helicopters are being fitted for ECMO and there is NOT much space in a helicopter, once you fit in two providers, a patient on a gurney and care equipment (most HEMS units are Bell 429s and EC/H-135s - MSP uses much larger AW-139s). https://live.staticflickr.com/3142/2639039443_ba623ddca0_b.jpg https://live.staticflickr.com/3142/2639039443_ba623ddca0_b.j... shows the working space on a -135. Note that access to most of the patient is heavily restricted - only chest and head, really. Still, to be clear, we are not really at the 'portable' stage either. There's about 65lb of equipment needed for an ECMO patient just for the ECMO itself, beyond other things like Lifepaks for monitoring.
      - iancmceachern 2y ago
        Thank yoi for what you do. If anyone wants to design a portable, integrated ECMO system reach out.
Animats 2y ago
Yes. The first recipient of an artificial heart was tethered to a sizable amount of hardware and confined to an ICU. Now, implanted artificial hearts are regularly used.
timr 2y ago
It has very little to do with the size and expense of the machine itself. ECMO requires 24/7 human maintenance because humans are messy dynamic meatbags, and tubes clog with clots, blood changes pH, people have an annoying tendency to move, etc. Every hospital with ECMO literally has "an ECMO team" to support the thing. It's mind-bogglingly expensive in terms of human capital. Other people on this thread are trying to imply that these things are like artificial hearts. That is true only in that the heart is one of the things that an ECMO machine attempts to replace. We don't have anything like an implantable artificial lung.
- jonah 2y ago
  TFA says that they're currently working on a portable (external) lung replacement[0]. I see no reason that it couldn't be installed in the chest cavity with a port for the O2 bottle connection. [0] https://archive.ph/0GP4F#selection-1103.0-1110.0:~:text=To%20that%20end,need%20a%20pump https://archive.ph/0GP4F#selection-1103.0-1110.0:~:text=To%2....
  - timr 2y ago
    Even if "they're currently working on" meant "it's available now or practical in the near future" (it doesn't), that doesn't affect what I said about the immense costs involved. The portability of the device is not the core issue here. It's a bit like arguing that you can build a quantum computer today, so therefore we'll all have one on our desktop soon.
    - xattt 2y ago
      Extracorporeal livers were being explored in the 1960s. It was advanced enough that it was included in a contemporary Time-Life book. Unfortunately, experimental success was not observed and the idea was shelved.
    - aidenn0 2y ago
      Nobody has said "soon" I think you inferred meaning that wasn't there.
  - 2y ago
credit_guy 2y ago
Exactly. This is progress. There is no ethical dilemma here, whatsoever. This is a technology that is keeping people alive. It's bulky, expensive, dangerous, etc, etc. But those things are not set in stone. In time it will become small, affordable, safe, etc. Until then, every little step should be celebrated.
- iancmceachern 2y ago
  It will, you are right. Anyone who wants to design hardware in the space feel free to reach out.
- flakeoil 2y ago
  > This is a technology that is keeping people alive. And in the meantime, let's have everyone who wants to walk around with a loaded gun.

by drxzcl 2y ago

sxg 2y ago

That's definitely not the main problem. Risk of intracranial hemorrhage/strokes and other complications make it problematic.

saurik 2y ago
But that isn't the problem from the article--the ethical issue of how to deal with a ton of people who are being kept alive on a "bridge to nowhere" when the machines might could be used in the interim to save many more people--as if you have an intracranial hemorrhage you are going to start down the road to actually dying. (And the article also talks about attempts to improve the bleeding problem anyway.)
- toth 2y ago
  To me it sounded like part of the problem is that people on ECMO cannot leave the ICU because at any moment they might have a complication that requires immediate emergency care. So it's not enough to make them smaller and cheaper, they also have to be made much less prone to these complications. I am sure that will happen in time, but I am also sure we'll be able to grow people new lungs in time
  - FireBeyond 2y ago
    Critical care paramedic: that's very much the bigger issue. Some life flight helicopters are being fitted for ECMO and there is NOT much space in a helicopter, once you fit in two providers, a patient on a gurney and care equipment (most HEMS units are Bell 429s and EC/H-135s - MSP uses much larger AW-139s). https://live.staticflickr.com/3142/2639039443_ba623ddca0_b.jpg https://live.staticflickr.com/3142/2639039443_ba623ddca0_b.j... shows the working space on a -135. Note that access to most of the patient is heavily restricted - only chest and head, really. Still, to be clear, we are not really at the 'portable' stage either. There's about 65lb of equipment needed for an ECMO patient just for the ECMO itself, beyond other things like Lifepaks for monitoring.
    - iancmceachern 2y ago
      Thank yoi for what you do. If anyone wants to design a portable, integrated ECMO system reach out.

Animats 2y ago

Yes. The first recipient of an artificial heart was tethered to a sizable amount of hardware and confined to an ICU. Now, implanted artificial hearts are regularly used.

timr 2y ago

It has very little to do with the size and expense of the machine itself. ECMO requires 24/7 human maintenance because humans are messy dynamic meatbags, and tubes clog with clots, blood changes pH, people have an annoying tendency to move, etc. Every hospital with ECMO literally has "an ECMO team" to support the thing. It's mind-bogglingly expensive in terms of human capital. Other people on this thread are trying to imply that these things are like artificial hearts. That is true only in that the heart is one of the things that an ECMO machine attempts to replace. We don't have anything like an implantable artificial lung.

jonah 2y ago
TFA says that they're currently working on a portable (external) lung replacement[0]. I see no reason that it couldn't be installed in the chest cavity with a port for the O2 bottle connection. [0] https://archive.ph/0GP4F#selection-1103.0-1110.0:~:text=To%20that%20end,need%20a%20pump https://archive.ph/0GP4F#selection-1103.0-1110.0:~:text=To%2....
- timr 2y ago
  Even if "they're currently working on" meant "it's available now or practical in the near future" (it doesn't), that doesn't affect what I said about the immense costs involved. The portability of the device is not the core issue here. It's a bit like arguing that you can build a quantum computer today, so therefore we'll all have one on our desktop soon.
  - xattt 2y ago
    Extracorporeal livers were being explored in the 1960s. It was advanced enough that it was included in a contemporary Time-Life book. Unfortunately, experimental success was not observed and the idea was shelved.
  - aidenn0 2y ago
    Nobody has said "soon" I think you inferred meaning that wasn't there.
- 2y ago

credit_guy 2y ago

Exactly. This is progress. There is no ethical dilemma here, whatsoever. This is a technology that is keeping people alive. It's bulky, expensive, dangerous, etc, etc. But those things are not set in stone. In time it will become small, affordable, safe, etc. Until then, every little step should be celebrated.

iancmceachern 2y ago
It will, you are right. Anyone who wants to design hardware in the space feel free to reach out.
flakeoil 2y ago
> This is a technology that is keeping people alive. And in the meantime, let's have everyone who wants to walk around with a loaded gun.