Last October, the Wall Street Journal published a fascinating article that delved into the ethical considerations for hospitals due to the ever-improving outcomes being seen with Extracorporeal Membrane Oxygenation (ECMO). And indeed, all decisions around life support must be made carefully and with compassion. However, given the skyrocketing survival rates and outcomes with ECMO, these decisions are quite rare.
The real ethical quandary among hospitals right now should be this: How can a hospital that’s serious about critical care or cardiac care not offer ECMO support?
ECMO has come a long way since its inception in the 1970s. By moving equipment that was initially developed to facilitate open-heart surgery out of the operating room, ECMO became a mainstay therapy for critically ill patients with severe respiratory or cardiac failure. With significant advancements in technology, more refined patient selection, and enhanced education and training, survival rates have increased dramatically in the last decade, exceeding 70% in most cases. The transformative potential of ECMO therapy has been realized by evolving technology and clinical refinement.
Recent studies validate ECMO’s efficacy. According to a recent study published in the Journal of Thoracic and Cardiovascular Surgery, 5-year survival rates among ECMO patients that survived to 30 days were 71-73% depending on whether both the heart and lungs or just the lungs were supported. These statistics reflect survival rates on par with other critical life-saving interventions, such as organ transplants.
Additional studies indicate a clear survival advantage of ECMO compared to conventional treatments. For instance, among patients with severe ARDS, those receiving ECMO demonstrated better survival rates than those managed with mechanical ventilation alone. This evidence solidifies ECMO’s position as a central pillar in critical care, comparable in significance to other widely accepted therapeutic modalities like dialysis.
Technological advancements have been one significant driver in the notable increase in patient survival rates. Early ECMO machines were large, clunky, and required meticulous manual adjustments, making it a challenging treatment option. However, modern ECMO systems are far more sophisticated, integrating digital controls for precise adjustments, durable and efficient oxygenators, and biocompatible materials that reduce the risk of blood clotting and infection. In addition, improvements in patient monitoring technology now allow for real-time tracking of vital parameters, enabling healthcare providers to rapidly respond to changes in a patient’s condition. This shift towards more refined and user-friendly technology not only makes the therapy safer but also broadens its applicability, allowing a greater number of patients to benefit from this life-saving therapy.
When any new medical technology is introduced, it takes time to gather data and gain insight into the technology’s clinical implications and therapeutic mechanisms. Cardiovascular surgeon Dr. John Mehall explains, “The evolution of ECMO mirrors the evolution of other new medical technologies. In the beginning, ECMO and structural heart treatments like Transcatheter Aortic Valve Replacement (TAVR) were only used on patients who had no other options and little hope of survival without treatment.”
With time and research, clear criteria have been developed to identify patients most likely to benefit from ECMO. Improved patient selection, in combination with well-established policies and procedures, have been instrumental in enhancing survival outcomes. “As our knowledge grew and the technology progressed, we moved to treating lower acuity patients earlier in their disease process,” Dr. Mehall says. “This shift has made ECMO an early option for patients with cardiopulmonary failure, just like TAVR is now the preferred option for low-risk patients.” These advancements ensure that ECMO is no longer a last-ditch effort but rather a strategic intervention in managing severe respiratory and cardiac failure.
Another important contributor to the rising survival rates is the progress made in healthcare provider education and training specific to ECMO. The new knowledge needed to deliver ECMO therapy necessitates specialized knowledge and skills, extending beyond the scope of conventional critical care management. Over the years, training programs and courses have been developed to bridge this knowledge gap. These education and training programs cover all aspects of ECMO, from its technical aspects to its clinical applications and potential complications. With didactic education and hands-on training with real clinical equipment, healthcare providers are well-versed in best practices for patient management while on ECMO. The continuous evolution of education and training has played a pivotal role in optimizing patient care and improving survival rates for ECMO patients.
The evolution of ECMO from a last-resort intervention to a mainstay of modern critical care is a testament to the relentless pursuit of better patient outcomes in the field of medicine. Unfortunately, despite the immense life-saving capability of this therapy, it remains vastly underutilized. Currently, out of an estimated 1 million Americans eligible for ECMO therapy annually, only around 10,000 currently receive this treatment. This represents a mere 1% of the potential patient population.
This significant gap highlights an opportunity to save countless lives that is currently being missed. If the reach of ECMO could be extended to even half of these eligible patients, an astonishing 1,000 American lives could be saved every day. As we move forward, the challenge and obligation lie in expanding access to ECMO and ensuring that this advanced therapy can bring hope to those in the most critical conditions, mirroring the success and widespread use of other cutting-edge therapies.
Photo: eakrin rasadonyindee, Getty Images
