Published On November 20, 2020
IN 1979, MGH RAN THE NATION’S FIRST RANDOMIZED controlled trial for a stunning new technology—extracorporeal membrane oxygenation, or ECMO. Patients whose lungs were in partial failure would be hooked up to a device that would siphon out their blood, fill it with oxygen and return it to the body.
ECMO offered hope for COVID-19 patients who couldn’t breathe on their own, and it had been mobilized in past pandemics, including the outbreak of H1N1 influenza in 2009. The procedure comes with significant risks, however, including blood clots and infection. Not every patient could benefit from it, and mortality from ECMO is traditionally as high as 50%.
The choice of whether to try ECMO became one of the more wrenching calls at the bedside. Faced with a dying patient, it was exceedingly difficult for a physician to deny the patient any shot at survival—even when ECMO was likely to be futile. “Making the decision to offer ECMO or to withhold it from a patient can be devastating emotionally and psychologically,” says Yuval Raz, medical director of Respiratory ECMO at MGH. To relieve that burden, Raz initiated a protocol that took that decision out of the single physician’s hands. A committee of at least four ECMO experts evaluated each patient’s likely outcome on ECMO and decided whether to administer. The team approach worked well enough that it will continue post-COVID-19, Raz says.
MGH had as many as 10 COVID-19 patients at a time on ECMO, which requires massive resources—labor as well as financial. One physician’s full-time job was to keep track of hundreds of ICU patients to identify those who might benefit from ECMO. As of early September, 23 patients had been on the treatment and about 60% of them survived.
MGH leadership didn’t suggest refusing ECMO referrals from other institutions, even though many patients were uninsured, Raz says. “MGH’s willingness to try to help anyone we could, including on ECMO, meant so much to me and my team,” he says.
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