ECMO: An artificial heart-lung set for COVID-19 treatment

Avani Dave, Jai Hind College

Extracorporeal membrane oxygenation (ECMO) acts as an artificial set of the heart and lungs, allowing a patient’s respiratory foundation to rest while proceeding towards a hopeful recovery. This mechanism has been put in a good word for, particularly during the two consecutive and rampant waves of the COVID-19 pandemic. ECMO is not only an extensively advanced form of life support but also very helpful when other forms are not deemed effective. 

Data Collection:

While the pandemic started to set its foot, active use of ECMO was recommended by WHO and the European Extracorporeal Life Support Organization (ELSO). Collection of data from the EuroELSO survey highlighted that COVID-19 patients witnessed clinical success with the utilization of Extracorporeal membrane oxygenation once a week. Data from the initial months were being documented, favouring the use of ECMO. Until a few months after being held in the jaws of the pandemic; studies warranted a better outcome with the use of steroids and thromboprophylaxis. 

Analysis of the data:

Data from the EuroECMO survey and several multicentre aggregates acted as a source of data collection,  spanning the first wave between March 2020 – September 2020. The resulting data endorsed a varying degree of survival rates, disposed of a satisfactory 55-60% landing on a less pleasant and alarming 30%. The data of Extracorporeal membrane oxygenation assistance in the case of COVID patients were under constant analysis throughout both the waves of the pandemic. However, the analysis during the second wave of the pandemic (September 2020 – March 2021) marked an abrupt change in the narrative in the discussion. In the form of the union of fatality and weaning curves, the results suggested a reduced survival rate accompanied by an increased rate of mortality. This trend was further supported by analysis of the deceased to weaned ratio, which escalated to less than 1 during Spring, 2020 to more than 1, currently. 

Most of the patients admitted to the hospital as a candidate for Extracorporeal membrane oxygenation showed the consumption of steroids and several adjuvants. Additionally, data centred around the second wave exhibited higher mortality in the case of COVID patients on mechanical ventilation. 

What did the analysis lead to?

This data may not be an independent corroboration to consider while sketching a verdict and hence, detailed analysis and breakdown of the trials would be needed. There may have been some underlying factors which either by themselves or in conjunction with other analogous ones, led to the skewed outcome during the second wave. 

For instance, 

• The altered time span for which mechanical assistance was administered during the two waves. 
• The need for an extended period of support in the case of patients with COVID-19 as compared to other illnesses. 

Since the data fails to provide a lucid foundation of identifying if ECMO therapy ranks the highest in effectiveness, several questions start bubbling up. Some of them are:

• Could we tap on a better outcome scale if ‘awake ECMO’ and ‘early extubation’ are brought into play?
• Would these considerations exert any influence on the disease course?
• When we fail to subjugate the effects of the disease, should ECMO therapy still be considered as the pinnacle of life support? 
• Should the therapy be discontinued or be practised, as a pass over to a tenable chance of lung transplantation in eligible patients?

These questions are arising due to the unpredictability, which can only be wiped off with relevant data, which conjures up the need for clinical discussions. Having said that, additional prediction models are required to allow accurate identification of patients that might be deeply benefited from ECMO therapy.

Also read: TINY platform uses HDA to detect Tuberculosis rapidly

Source:

Broman, L. M., Eksborg, S., Coco, V. L., et al. (June16, 2021). Extracorporeal membrane oxygenation for COVID-19 during first and second waves. The Lancet. https://doi.org/10.1016/S2213-2600(21)00262-9

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About Author: Avani Dave is currently in the final year of her bachelor’s degree, majoring in Life Sciences. Holding a good academic and extra-curricular record, she is on a constant journey of acquiring exposure in her field of interest while simultaneously not limiting herself to just that. Avani likes studying Diseases and Syndromes and everything under this umbrella! That being said, she is adept at working across departments and promises to deliver.