First long-term data on life-saving ECMO treatment published
A world first study, led by critical care researcher Professor Carol Hodgson, has found that following life support involving Extra Corporeal Membrane Oxygenation (ECMO), death and disability were common, with just one third of patients alive and without disability at six months after starting treatment.
ECMO is a recent life-saving development in critical care, providing respiratory support for patients unable to breathe on their own. The costly and complex machines extract blood, and remove carbon dioxide and re-oxygenate the blood, before returning it to the body.
The technology is certainly life-saving for some, but the rapidity with which it was embraced during the pandemic means that despite wide-spread adoption, few studies have assessed the conditions under which it can be used most beneficially and cost-effectively.
The study was published in Lancet Respiratory Medicine. It’s the first long-term prospective, multicentre cohort study looking at the incidence of people surviving with or without disability following the use of ECMO in intensive care units. The research is important not only to build an evidence base for best practice, but because patient’s families are often unaware of the long-term consequences of ECMO, according to Professor Hodgson.
“It’s been very difficult to conduct ethical randomized trials on these very unwell patients – that is, offering a potentially life-saving therapy like ECMO to one group, but not to another,” she said.
The study drew data from the EXCEL Registry, Australia’s national clinical registry that launched in 2019 to capture standardized data on ECMO use and patient outcomes. The data in this study covered 391 patients from 23 hospitals, who were treated with ECMO between February 2019 through to December 2020, representing both pre-pandemic and early pandemic usage.
Disability was common across all areas of functioning six months after commencing treatment, including physical, psychological and cognitive domains.
“Intensive care admission is only for the sickest patients, and that degree of sickness often results in a very long road to recovery, physically and cognitively. It can also create huge psychological strain, as people may be traumatized by their experience, and feel sadness and frustration at struggling to undertake ‘simple’, everyday activities.”
ECMO is an expensive undertaking - the average cost is $200,000 per patient. Professor Hodgson says that clinicians are currently divided by those who believe it should be provided to all patients in need, while others argue that it should be relegated to only those who will benefit, with financial savings used on more proven treatments.
“We still have a lot to learn about which patients will have a good outcome after ECMO,” Professor Hodgson said. “I do think it’s important the patient’s family are given information about the risk of disability once a patient is on ECMO.”
Professor Hodgson is collaborating with colleagues from around Australia to develop new guidelines for the NHMRC on the use of ECMO.
Read more about ECMO here; and read patient experiences after ECMO here.
Read more about Professor Hodgson’s work in Intensive Care research here.
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