As the spread of coronavirus continues, medical experts are looking at ways to help the most severely affected, including extracorporeal membrane oxygenation (ECMO).
What is ECMO?
Extracorporeal membrane oxygenation (ECMO) is a life support machine. People who need ECMO have a severe and life-threatening illness that stops their heart or lungs from working properly. For example, ECMO is used during life-threatening conditions such as severe lung damage from infection, or shock after a massive heart attack. The machinery works by removing blood from the person's body, oxygenating the red blood cells and removing carbon dioxide.
Coronaviruses (CoV) are a large family of viruses; COVID-19 is the most recent mutation. It attacks the respiratory symptom, causing coughing and shortness of breath. It causes severe respiratory disease in around 20% of cases and so far, statistics have shown it has killed 2-3 per cent of infected individuals. Older people, whose immune defences have declined with age, and those with underlying health conditions are much more vulnerable than the young.
The World Health organisation has established interim guidelines for treatment if symptoms become severe. One way of helping patients survive may include ECMO. The life support machine has been used to treat a few patients in China, however, there are no clinical details on the patients, the criteria for selection and outcomes.
According Dr Sundeep Kaul, a consultant in intensive care and respiratory medicine and lead respiratory consultant at Harefield Hospital, ECMO should be seen as less of a treatment and more as a stabiliser. In a blog about innovations in intensive care, he wrote: ‘[ECMO] allows you to stabilise patients to get better on their own or with treatment. It’s a bridge to something else which may be recovery on their own or a transplant, or a mechanical heart device or last stages of life.’
How many ECMO machines are available?
In the event of patients requiring ECMO is only available at a few specialist hospitals in England. There are five adult ECMO centres in the UK, two of which are in London and the others are based in Leicester, Manchester and Cambridge.
On average, the cost of ECMO treatment per patient in England is £45,000 and there are 15 available beds for adults at five centres across England.
Inevitably, this will mean ECMO will have to be rationed. NHS doctors have spoken out about the “three wise men” protocol, where three senior consultants in each hospital would have to decide which patients would be mostly to benefit from care such as ventilators and beds, in the event hospitals were overwhelmed with patients.
Until a viable vaccine or treatment has been developed for this COVID-19, we should focus on prevention and stopping its spread to vulnerable patients.
Stopping the spread of Covid-19
Data from the Chinese Centre for Disease Control and Prevention (CCDC) finds that more than 80% of the cases have been mild. However, most experts agree that the best way to protect the most vulnerable groups is to stop the virus spreading. We can all play out part by
- Ensuring we thoroughly wash our hands very regularly, or use an alcohol-based gel when soap and water isn’t available
- If someone is coughing or sneezing, keep a three feet distance away
- Keep your mouth covered with a tissue when you cough or sneeze. However avoid sneezing into your uncovered hand, rather catch your sneeze in the crook of your elbow
- If you develop symptoms, stay indoors and avoid contact with other people
- Call NHS on 111 if you develop flu-like symptoms, or seek advice from a GP – making sure you explain your concerns by phone beforehand, so you can be best advised.
