It is difficult to find high-level life support in the COVID-ravaged South.
Click to enlarge the image and toggle caption Blake Farmer/Nashville Public Radio Blake Farmer/Nashville Public Radio
Phoua Yang's discharge day from hospital was more like a pep rally.
As streamers and confetti fell on her, she wept as she made her way out of Centennial Medical Center Nashville. As she was being wheeled out of Centennial Medical Center in Nashville, nurses chanted her name. She had been there since February when she was barely breathing and COVID-19.
This 38-year-old mother, who is a chemist by trade, is living proof of the effectiveness of ECMO. This method oxygenates a patient's blood and then pumps it back in. This story helps to explain why COVID-19 hospitalizations have risen due to a shortage in trained personnel capable of operating the machines.
Yang said that she was able to spend a lot of time on the ECMO machine. "One hundred forty-six days is a long period." It's been a long journey for me.
Yang was unable to sleep for nearly five months because her blood pressure was high.
ECMO, the highest level of life-support beyond a ventilator is the highest. It pumps oxygen through a tube down into the lungs. The ECMO process functions in a similar way to a heart and lungs.
This process is more commonly used before the pandemic of organ transplant candidates. However, it is not a treatment. It does allow patients with COVID-19 to rest and heal. Many patients have been on a ventilator for quite some time. Even if the ventilator is working well, it can cause side effects such as nerve damage and damage to the lungs from the high levels of air pressure.
Doctors often refer to ECMO as a way for the lungs to "rest", especially when ventilation isn’t completely oxygenating a patient’s blood.
Many more people could be able to benefit from ECMO than those who are currently receiving it. This has led to a complicated triaging of treatment. It could get worse as the Delta variant surges in the South and rural areas with low vaccination rates.
ECMO is labour-intensive and costly.
The ECMO gridlock stems primarily from the number of people required to care for each patient. One-on-one nursing is essential, and this can be done 24 hours per day. Problems such as staff shortages in hospitals located in hot zones only make matters worse.
Yang said that she had sometimes four to five nurses helping her to walk the halls of the hospital. Yang said that one person was responsible for making sure her hoses didn't get kinked while she was moving, as the machine was literally keeping it alive.
According to Kristin Nguyen, a nurse who works in Vanderbilt University Medical Center's ICU, ECMO patients require the most attention of all those being treated.
After a one-on-1 shift with an ECMO patient, she says that "it's very labor-intensive."
According to the Extracorporeal Life Support Association, the average ECMO patient with COVID-19 spends 2 weeks on the machine. However, many doctors say that their patients typically spend a month or more.
Nguyen said that these patients take so much time to heal, and they are eating up our hospital beds as they come in and stay. "And that's why we're in such a tight spot."
These patients are not well-treated in hospitals.
It's not as if there aren't enough ECMO machine to go around, or that the cost is too high at $5,000 per day (or significantly more depending on where you live).
"There are many ECMO machines, it's the people who know how it runs," Dr. Robert Bartlett of the University of Michigan, who pioneered the technology, says.
Every hospital for children has ECMO. It's used regularly on babies with pulmonary problems. Bartlett said that ECMO was not used by other teams prior to the pandemic. They might only use it a handful of times a year.
This is a high-risk intervention that leaves little room for error. It requires a 24/7 team.
Bartlett states, "We don't believe it should be that every hospital has ECMO."
Bartlett said that his research team is working on making ECMO available outside of an ICU. Patients may even be able to take it home with them. However, this is still years away.
Only the most prestigious medical centers currently offer ECMO. This means that many hospitals in the south are still waiting to be able to transfer patients to major medical centers during the recent pandemic. There is no official way to make these transfers. The larger hospitals also have COVID patients who are eligible for ECMO and would be open to trying it.
"We must make difficult choices. It really comes down to your health and availability. Dr. Harshit Rao is the chief clinical officer responsible for overseeing ICU doctors at Envision physician services company. He is a member of ICUs in Houston and Dallas.
Although a national non-profit has established a registry, there is no process for prioritizing patients. There is limited data about which factors may make patients with COVID-19 more likely to receive ECMO than other patients.
ECMO has seen a rise in demand from younger patients.
ECMO was used throughout the US pandemic. However, there was not as much shortage in the beginning because COVID-19-related deaths were more common among older people. ECMO is not recommended for people over 65 or who have health issues that could prevent them from receiving the full benefits of the treatment.
Before the pandemic, there was much debate over whether ECMO was simply a costly "bridge to nowhere" option for many patients. Currently, the survival rate of COVID-19 patients receiving ECMO is approximately 50%. This figure has been declining as more sicker patients' families push for life-support.
The calculation is different for COVID-19 patients younger than the rest, who are largely unvaccinated. This means that there is more demand for ECMO.
"I believe it's 100% directed towards the fact that they are younger patients," Dr. Mani Daneshmand who oversees the Emory University Hospital's transplant and ECMO programs, says.
Daneshmand explains that Emory, despite being a huge hospital, is refusing multiple requests per day to transfer COVID-19 patients needing ECMO. Calls are also coming in from across the Southeast.
You can call if you have a 30-year old, 40-year-old, or someone just becoming a parent. He says that he has received calls from 18-year-olds. "There are many young people who need a lot support and some of them are dying."
Even younger people have better chances of ECMO. Many are still debilitated.
Laura Lyons was a comedian who had a day job in New York City just before the pandemic. She was only 31 when she contracted COVID-19 and almost died. She says that ECMO saved her life. She may never be the exact same again.
She says, "I was running around New York City about a year ago, but now I'm in an electric wheelchair." "My doctors told me that I would be on oxygen for life, and I refuse to believe them. "I don't see my life tied to a cord.
Lyons lives with her parents in central Massachusetts and spends her days doing physical therapy. She is still fighting for her strength, but she is alive.
Some families make their appeal for ECMO known to the public
Some families are desperate to get their loved ones an ECMO mattress, but it is not easy.
Toby Plumlee began to press her doctors about ECMO as soon as his wife, Toby Plumlee, was placed on a ventilator in august. The family looked 500 miles away for help after she was admitted to a North Georgia community hospital.
He says, "But the more research you do, the more information you read, and the more you talk with the hospital, you will see how severe the shortage is." "When you get to that point, all you can do for your loved ones is to pray that they will survive.
Plumlee said his wife was sixth at a Centennial Medical Center 200 miles away, where Phoua Yang was completing her 146-day ECMO Marathon.
Yang left with a miracle. Plumlee and their three children were left in grief. He died just days after turning 40.
This story was created as part of NPR’s partnership with Kaiser Health News, Nashville Public Radio and Nashville Public Radio.
