Curious as to other inpatient doc experiences. How much is it being utilized for COVID salvage? We only have 3 units. Thoracic surgery inserts the lines (VV) and manages ECMO at our hospital. Despite numerous consults since March (and consulted tonight on my 40 y/o) they have done none. Zero. Citing limited units and the need for cardiovascular surgery. However - I have asked CCU RNs who tell me all 3 are never being used at one time. I understand the exposure risk etc. But I think it's indicated for young healthy pts on the brink of death. We are begging hospital to purchase 3 more.

Marcus Aurelius said:

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Curious as to other inpatient doc experiences. How much is it being utilized for COVID salvage? We only have 3 units. Thoracic surgery inserts lines and manages ECMO at our hospital. Despite numerous consults since March (and consulted tonight on my 44 y/o) they have done none. Zero. Citing limited units and the need for cardiovascular surgery. However - I have asked CCU RNs who tell me all 3 are never being used at one time. I understand the exposure risk etc. But I think it's indicated for young healthy pts on the brink of death. We are begging hospital to purchase 3 more.

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I would agree.

I would agree as well. I've seen ECMO do some amazing stuff, even in the pediatric world (8 year old lightning strike).

But surgeons... will be surgeons... neurosurgery once turned down a consult to drain multiple epidural and spinal abscesses (some more symptomatic than others) on an IV drug user that was HepC positive. Ended up getting IR to hit some, but they didn't feel comfortable hitting one of the big ones.

Does thoracic surgery own the machines? Can you consult another surgical service? CT surgery, or even trauma? Is it a laziness thing? Or are they just scared of getting COVID and having COVID patients on their floor?

We're using it more liberally, but we also don't have the same unit limitations as it sounds like you guys do. We also have a number of non-surgeons who can cannulate a patient if needed.

It works in the right patient population. Before COVID I always felt we were a bit too liberal with ECMO (my understanding is the benefit hasn't really been shown outside of young, relatively healthy patients and I'd see 65 year old COPD patients on it from time to time) but I've seen multiple patients walk out of the hospital over the last 9 months after being on ECMO for COVID.

As someone else said, surgeons gonna surgeon though. I can't tell you how many hours I've spent trying to convince neurosurgeons or CT surgery or orthopedic surgeons or urology to do something that the patient needed but they didn't want to do. A huge part of my field is making surgeons understand that antimicrobials only work if you also fix the source, they won't magically clear that giant abdominal abscess or fungal endocarditis by themselves.

ENT and OBGYN are usually the most willing to work with you in my experience, they'll go after just about anything within their wheelhouse of I tell them it's really needed.

We have 15 total. I think at our peak in July we had 12 people on it at once, all relatively young individuals. We were doing awake cannulation on almost half of them. Per our CCM docs, they were seeing excellent results in the patient population they were using it on.

At our institution the MICU docs meet with administration to determine candidacy and then basically tell the thoracic surgeons to cannulate. After cannulation the surgeons don't come back until it's time to de-cannulate, so we don't ever get push back from them.

That said, we've had many patients who in pre-covid times would be excellent candidates that administration has said no to, citing the nursing ratio needed to run a patient on a circuit. You basically gotta be Lance Armstrong who gets Covid ARDS to go on ECMO here. The results have been overall positive but still have had some bad outcomes.

Extracorporeal membrane oxygenation. I looked it up. Do they store the patients conscience in the cloud, like i assume they would with that name?

A 41yo family friend was just transferred between systems (Presby Allen to Baylor Dallas) to be admitted to the ECMO unit. I remembered reading about it here, so searched for this post.
So, first, thank you again to the doctors and healthcare professionals who are sharing their knowledge and insight with us.
Second, any insight on what might happen next would be appreciated. Any idea how long it might take to see improvement if improvement will happen?
Again, thank you all so much for your time and expertise.