
ECMO pumps blood out of the body, oxygenates it and returns it to the body - howard941
https://khn.org/news/miracle-machine-makes-heroic-rescues-and-leaves-patients-in-limbo/
======
seriocomic
I'm alive now because of this machine/technology (well, maybe the truth more
lies in the fact that I was geographically close to where an ECMO machine was
available when I fell ill).

I fall in the more rare category of ECMO patients as one machine wasn't able
to process/oxygenate enough volume safely to keep me alive and so I had two
running in parallel - making my situation even more privileged by being at a
hospital (Alfred Hospital - Melbourne, Australia) that had that availability.

I spent 7 days hooked up to the ECMO machines after my lungs failed due to
Pneumonia > ARDS - and complicated by other organ failures. 19 days in total
unconscious in ICU. You can read about my experience here -
[https://www.seriocomic.com/rhetoric/fragility](https://www.seriocomic.com/rhetoric/fragility)

Clearly, the choice of this treatment/intervention should only be used in the
most extreme cases and when there are few other options. But I'm all for
having this type of life-saving medical treatment more widely available so
that people less fortunate than I can continue to receive the gift of life.

~~~
SubiculumCode
Thank you for sharing. I am glad you made it through that.

When you mentioned that you needed two machines, I thought perhaps you were
especially obese, but that does not appear to be the case from the pictures
you shared.

Edit: Why am I being downvoted? I was curious about why two machines were
needed? From the link he shared, he seems a normal sized male.

~~~
Choco31415
From his's wife's diary, it was necessary because the insertion site for the
original was not working as expected:

"Wednesday, 27th of August 2015 – Day 9

The nurse explained to me that they put another line in your neck, just to get
extra line of blood to the lung machine as you need more oxygen to keep other
organs working well. Your lung still is quite sick, the tube into your lung
wasn’t working much comparing to the one from the lung machine."

A little more context:

"Monday, 25th August 2015 – Day 7

Your oxygen level requirement is 100% now, in case during night time at 3am,
you need more oxygen, and there is no way they can feed you more here in Knox.
So they need to cut a hole in your leg to put a man-made lung to pump extra
oxygen in your body (as your lung is too inflamed), which can only be done in
Alfred hospital."

------
devilmoon
My mom is alive thanks to this machine!

A few years ago she got Legionella pneumophila and had to go in
pharmacological coma for more than a month in order to survive, we were very
lucky because my dad decided to not trust our GD and bring her to the biggest
hospital in the city (only one of two with an ECMO in the whole country at the
time).

I thank the amazing people working in medical research for this amazing
device, had she got ill a few years before she would've surely died, instead
thanks to human ingenuity she is still here, was able to see her son graduate
and I hope we will be able to share many more years together. Seriously, if
you work on these machines, thanks from the bottom of my heart and keep up the
good work!

P.s.: What the actual fuck is up with the US and its medical costs? 4 million
dollars for a stay hooked to this machine? We paid a grand total of 0€ for the
whole stay, and after being in the ICU for close to two months my mom spent at
least another three in the hospital. This is crazy, even if you add up a life
time of taxes paid into the system by all our family members you wouldn't even
begin to get close to that kind of number. I am truly convinced socialized
healthcare is the only way forward, thinking that my mom could've been dead
because we didn't have enough money in the bank sound so fucking dystopian

~~~
RomanBob
>This is crazy, even if you add up a life time of taxes paid into the system
by all our family members you wouldn't even begin to get close to that kind of
number. I am truly convinced socialized healthcare is the only way forward,
thinking that my mom could've been dead because we didn't have enough money in
the bank sound so fucking dystopian

If you didn't pay for it, somebody did.

Why should a stranger be forced to pay for your medical care?

~~~
devilmoon
>Why should a stranger be forced to pay for your medical care?

It's always nice to know that there are human beings around that would prefer
not to pay a very small sum of money into the system in order to save the life
of another human being because apparently taxation is theft. What kind of
fucked-up world view is that? Do you really believe that the life of someone
with a fat bank account has more intrinsic value than that of someone who is
poor? Law and Healthcare should be the two things where everyone is completely
equal and deserving of the same respect and care, the money you make should
never dictate whether you live or die.

I really, truly hope you will never find yourself in the situation where a
loved one's life is hanging by a thread, and that thread might be cut just
because you ran out of money. If you can't emphasize with someone in that
situation, or worse it, you can imagine yourself not caring or rationalizing
the outcome, then I feel very sorry for you and hope you'll be able to find
peace within yourself and learn to love other human beings a bit more.

------
iancmceachern
Full disclosure- I design medical devices like these, including many blood
pumps and an ecmo device or two.

Ecmo is just now becoming (semi) widely adopted. Until recently hospitals had
to cobble together their own systems from a collection of pumps, oxygenators,
tubing and monitoring equipment. Only in the last few years have integrated
systems and platforms come to market. These devices are in their first
iterations, it's still early times. The hardware tech and medicine are both
evolving rapidly and thus so is the standard of care. As is my experience with
similar devices in the next ten years the ~50% survival rate will steadily
creap up to above 80%, and the adoption will follow.

My experience in another, related space makes me very confident. LVADs, left
ventricular assist devices awere once a sci fi dream and are now common, and
extremely effective. People with what once was end stage heart failure are
able to live for a decade or more having their heart supported by a tiny
implanted pump the size of a F battery that spins at thousands of RPMs all
day, every day. In many cases it's a better option than a heart transplant.
It's so mainstream now that as of a few years ago the two most successful LVAD
companies are now divisions of Medtronic and Abbott after large acquisitions.

Next up is ECMO and artificial hearts.

Anyone interested in whats next in this space should check out Ventriflo
www.ventriflo.com, Bivavor www.bivacor.com and for some great history read
"Ticker" by wired author Mimi Swartz.

There is so much more...

------
chancla35
$0.02 from a doctor who has cared for ECMO patients in the ICU, and delivered
anesthesia for multiple open heart surgeries and heart +/\- lung transplants.
Generally speaking, patients on ECMO tend to do well if (and only if) they
need ECMO due to a reversible cause. Examples include prematurity (kids will
grow up), a particularly virulent strain of the flu in a child or young adult
(I believe the OP falls into this camp), and open heart surgery. There's also
some evidence to support the use of ECMO for a very short period of time in
the setting of some acute strokes.

It's important to note that ECMO will NOT reverse disease in and of itself.
This explains why some doctors believe that ECMO has no role in the treatment
of patients with end-stage disease of any kind. Some even argue that ECMO
amounts to cruel and unusual punishment. While I don't personally agree with
the latter view, I do believe that we (doctors, patients, and their loved
ones) must recognize ECMO for what it is: a means to an end.

While it's exciting to learn about technologies like ECMO, it would be a
fool's errand to try to make it more portable, cheaper, etc. I strongly
encourage the HN community to keep their eyes on the prize by applying their
talent to discovering new ways to predict, prevent, and treat the conditions
that land people on ECMO in the first place: \- Heart disease \- Diabetes \-
Cancer \- Liver disease \- Infectious Disease \- Prematurity \- Aging

P.S. - love to see medical stuff make it to the front page

~~~
fiter
It's not clear to me why it would be a fool's errand to make it more portable,
cheaper, etc.

Was the iron lung[0] only useful as a bridge?

Was there no reason to invent implantable pacemakers?

If you can enable a person to live a normal enough life outside of a hospital,
I think this is a worthwhile goal. There are disabilities that make life more
difficult to live than needing to carry around your heart/lungs outside of
your body.

[0]
[https://amhistory.si.edu/polio/howpolio/ironlung.htm](https://amhistory.si.edu/polio/howpolio/ironlung.htm)

~~~
petschge
ECMO is not sustainable for long. The extra mechanical stress on the platelets
and all the precautions you have to take against blood clots forming on any
off the artificial surfaces are rather damaging. And since it is an expensive,
short-term-only intervention there is no need for it to be particularly
mobile. For the few days to weeks you are on ECMO while quite seriously ill,
the ICU is the best place for you.

Ventilation on the other hand doesn't interact with your blood, but only has
to handle air, which doesn't get damaged by the vent. So it is not impossible
to be on a vent for decades. Being locked in the ICU for decades would not be
good and luckily is not necessary.

~~~
fiter
Are you saying those details cannot be resolved or are you just talking about
ECMO as it exists today?

~~~
petschge
Most of those problems have been considered unsolvable for a long time. Recent
advanced in artificial hearts and heart assist devices (LVADs) have shown that
at least a small fraction of the problems can be solved. For the rest? I'm not
even sure if we know if they are solvable or not.

------
stupidcar
While I can understand the disquiet about loading patients onto this device
when it's a bridge to nowhere, in terms of treatment and recovery, wouldn't it
better to look at this in a more positive way: As providing the necessary (and
astonishing, technologically speaking) first step in being able to treat
previously untreatable conditions.

I'll bet that over time the technology will improve and require less intensive
management, and for every patient who ends up in an unpleasant twilight
between life and death, there's going to be one whose short-term survival
inspires doctors to find a way to get them off ECMO. Long-term survival and
recovery rates will improve as the years and decades go by, and eventually
technology like this will be a regular and uncontroversial part of medicine.
Doctors will look back on these early days like we look back on early surgery:
as the hardest part of a learning curve that eventually pays off handsomely.

~~~
kitrose
From a layman’s perspective, what I often hear ECMO being used for is to allow
the heart/lungs recover for a while from the sheer trauma of a heart attack or
surgery while not bearing any critical load.

~~~
pfdietz
I'm told it's also used in cases of very severe asthma.

------
ChuckMcM
Fascinating, if somewhat depressing[1] read.

What struck me was that the ICU is required for ECMO patients because they are
at risk for other complications like blood clots. At what point do we have
mobile wheel chairs of the 'Captain Pike'[2] variety where the wheel chair
provides most of the organ functions for a person? And then where does that
put us on the life/death scale? I can't help but think that practicing
medicine is going to be even more complex ethically in the coming decades.

[1] The whole choosing when to turn off grandpa vibe is super depressing to
me.

[2] Captain Pike - a character in the Star Trek pilot episode who was confined
to a wheel chair that provided all functions, his only communication was a
light that blinked once for yes and twice for no.

~~~
fao_
I can guarantee, if you can provide the entire body's function in a
wheelchair, you can slap arms on that had have them movable by a person. We're
talking at current level of tech.

~~~
ChuckMcM
Absolutely, and have them move by brainwaves. It was one of the more amusing
things that Star Trek didn't go far enough to be the future (like they can't
cure male pattern baldness but give someone a pill and they grow a new kidney)
but science continuity aside. Where does that leave us with an ethical
obligation to people who are alive but not alive. Imagine if Pike got
Alzheimers, when would Starfleet pull the plug on him? It is an ethically
challenging place.

~~~
deathanatos
> _At a press conference about Star Trek: The Next Generation, a reporter
> asked Star Trek creator Gene Roddenberry about casting Patrick Stewart,
> commenting that "Surely by the 24th century, they would have found a cure
> for male pattern baldness." Gene Roddenberry had the perfect response._

> _" No, by the 24th century, no one will care."_

[https://boingboing.net/2015/07/08/star-trek-creators-
perfect...](https://boingboing.net/2015/07/08/star-trek-creators-
perfect-c.html)

~~~
fao_
Funnily enough, I think either Rick Berman or Patrick Stewart actually had to
talk Gene Rodenberry into that realization.

------
kitrose
My wife is a perfusionist (specialist who runs these pumps and similar ones
while the heart is being operated on).

ECMO’s really an incredible feat of medicine that can bring people back from
the edge where they would otherwise die.

~~~
Jare
My son spent 10 of his first 15 days of life plugged to an ECMO (he's 5 years
old now!). Through the pain, fear and despair of 3 failed attempts to get him
out of it, one of the thoughts that my head clung to for sanity was exactly
what you describe, that awe of what the machine's power, and awe at the
amazing people who, like your wife, tended to it and to my son.

~~~
lsaferite
My daughter spent her first 10 days of life on ECMO. She had severe Meconium
Aspiration Syndrome (MAS) and mild Patent Ductus Arteriosus (PDA). She's a
happy and healthy 6 y/o now. It was terrifying to watch them try to keep her
alive for 4 hours in NICU2 the hospital where she was born. They eventually
gave up and medevaced her to a hospital with a NICU3. Once she went on ECMO we
had hope she might actually survive. ECMO is amazing.

------
throwaway78145
My son, born two weeks late needed ECMO and was on it for a span of a week in
2005. He was septic due to a severe case of Meconium aspiration and unable to
breathe even with the most aggressive ventilator (and as the doctors informed
me, it would likely damage his lungs pretty badly as the pressure required to
get him to proper levels of oxygen in the bloodstream were pretty rough) Today
he is perfectly fine (in fact a cross country runner), and I of course thank
that machine. It is an amazing machine. Which reminds me, it's probably time
to give blood!

~~~
throwaway1239jj
Same story here.

My daughter was born in 2006 with meconium aspiration. Nurses hand-bagged her
for 8 hours before taking her in ambulance to the nearest ECMO facility.

She was on ECMO for a few days, and miraculously recovered.

We took her to followup clinics every few months, expecting some sort of
learning disabilities or lung damage. Turns out there were zero complications.

Today she is completely fine!

------
forgotpwagain
The stories in this piece really highlight the importance of having these
tough conversations with family members about what you want to happen for your
own medical care if the worst happened.

I really enjoyed Being Mortal by Atul Gawande (author of The Checklist
Manifesto), that tells intensely personal stories about, well, the process of
dying, and the increasingly prolonged tug of war between medicine and death.

One thing that may be a bit of a challenge is how quickly things change in the
technology world. "Code Status" is medical lingo for the descriptor of what
the patient expresses they want to have happen if their heart or breathing
were to stop. Most people are full code - CPR, mechanical ventilation, etc.
But patients can choose to be DNR/DNI, meaning "Do Not Resuscitate, Do Not
Intubate", meaning very limited interventions would be performed.

As the tech gets better, I wonder if a more sophisticated decision tree might
be needed in the future -- if XYZ happens where 30% of patients make a
recovery, begin ECMO, but if ABC happens in which only 5% of patients recover,
do not start ECMO.

------
xwdv
Wow, so a person could really be as extremely lucid and awake as you are now,
but hooked up to an ECMO, knowing that there’s no hope and with one flick of
the switch it’s all over?

~~~
whatshisface
If it happened to someone like Bill Gates, maybe they'd decide to stay on it
until somebody invented a portable version. Another interesting thought is
that if the price of this thing falls a bit, there might be a few high-power
professionals and executives who make more in an hour than the future ECMO
costs to run. It doesn't look that big, maybe before long there will be a
billionaire that travels around with a personal perfusionist wheeling an ECMO
unit behind them. After that millionaires will start doing it, and in the end
there will be affordable and entirely artificial respiratory systems.

~~~
albertgoeswoof
You think someone on ECMO is going to work?

Go take a look at an ICU ward, conscious or not these people are seriously
unwell and as close to death as humanly possible.

Even the rich ones.

~~~
serf
Yeah, except the kid mentioned in the parent article which divided clinicians
as to whether or not their quality of life allowed for their decision to pull
the plug.

He was 'seriously sick', but he had a certain quality of life that was unusual
for ECMO patients.

 _...The boy was fully conscious, doing homework, texting friends and visiting
with family. But after two months of living in the ICU, he was diagnosed with
untreatable cancer that made him ineligible to receive new lungs.

Clinicians were deeply divided over what to do next, Truog said. Some wanted
to stop ECMO immediately because its original goal — a bridge to
transplantation — was no longer possible.

Others argued that even though he couldn’t survive outside the ICU, the boy
seemed to have a good quality of life on ECMO, and his family and friends
“derived benefits from his continued survival,” Truog wrote. They argued that
the family should have the right to continue this form of life support, just
as with dialysis, ventilation or an artificial heart.

A third argument arose, Truog said: If leaving this patient on ECMO was
appropriate, then in fairness “why don’t we put everyone with respiratory
failure on ECMO?”

For the parents, Truog said, it was “unbearable” to choose a day or moment to
turn off ECMO, because they knew their child would immediately die.

Clinicians devised an alternative the family would agree to: They decided not
to replace the ECMO oxygenator, a part that needs to be changed every week or
two when it develops blood clots. After about a week, the oxygenator gradually
failed and the patient lost consciousness and died, Truog said.

The solution “allowed him to die in a way where we didn’t feel like we were
choosing the moment of his death,” he said...._

~~~
JoshTriplett
> A third argument arose, Truog said: If leaving this patient on ECMO was
> appropriate, then in fairness “why don’t we put everyone with respiratory
> failure on ECMO?”

That's not an argument against, that's an argument _for_. Why _don 't_ we? The
only reason not to would be cost.

------
vegardx
A couple of years ago such a machine was transported between two hospitals in
Trondheim and Bodø (450km), using a F-16 fighter jet. It all started with a
phone call from a doctor at St. Olavs Hospital with what he described as an
unusual request for assistance.

A fighter squadron was just about to take off from Ørland going to Rygge for
training, and by chance one of the fighter jets was fitted with a cargo bay.
They held that fighter jet back and re-routed it to Bodø, where machine was
needed. A medical helicopter transported the machine from Trondheim to Ørland.
From the helicopter landed at Ørland to the fighter jet delivered the machine
at Bodø it took 40 minutes, a trip that usually takes 35 minutes alone. The
machine arrived just before the trauma team.

The patient survived.

------
pcj-github
As a former vascular surgeon and having worked with this directly, ECMO is
definitely an amazing lifesaving medical technology if used appropriately.
Unfortunately there is a perverse incentive to have more ECMO patients as they
can generate huge insurance bills. So, the hospital loves it if the patient
attached to it has insurance (and hates it otherwise).

------
inflatableDodo
Has anyone who is conscious and going to get the plug pulled tried to kidnap a
nurse and sneak out with the ECMO yet?

Was also wondering how long it will be before the tech is safe enough for
healthy people. Is what you need for hi-G air and spacecraft if you don't want
to be breathing liquid.

edit - your lungs would still be full of liquid, but apparently breathing
liquid is not that great a plan, even though it is technically possible.

------
legohead
You can always build more ECMOs. I imagine the technology will get more
advanced too, eventually portable. Turning it off for lucid users doesn't seem
like an appropriate choice.

------
alister
What's not explained is the difference between this _latest miracle machine_
called ECMO and the plain old heart–lung machines (aka cardiopulmonary bypass
or CPB) which I'm confident that most people have heard of. Note that
heart–lung machines oxygenate blood just like ECMO. As far as I can tell,
heart–lung machines are used only during surgery whereas ECMO seems to serve
exactly the same function but comes in self-contained packaging so it can be
used longer term outside of surgery.

Could someone with more domain knowledge tell us if ECMO really is _an
entirely new paradigm_ like the article claims?

------
alleycat5000
Reminded me of this excellent read,
[https://en.m.wikipedia.org/wiki/Being_Mortal](https://en.m.wikipedia.org/wiki/Being_Mortal)

------
alexgmcm
This combined with the recent BrainEx paper[1] makes me wonder how far away we
are from "Brain in a box" style immortality.

[1]
[https://www.nature.com/articles/d41586-019-01216-4](https://www.nature.com/articles/d41586-019-01216-4)

------
zepto
A billionaire could use this to remain alive for decades after they would
otherwise have died - long enough for cloned organs to be grown to replace the
ones that are failing.

~~~
lsaferite
Every day on ECMO is a roll of dice. There is a severe risk of clots. They
could cause arterial blockages and strokes. They have to put you on blood
thinners to combat the clots. The blood thinners could cause brain bleeds.
There's also the risk of infections and the constant feed of antibiotics to
combat that. ECMO, at least as it is right now, isn't meant to be a long term
solution. As they said in the article, it's merely meant to be a bridge.

Edit: that's roughly $1800/hr for the stay I think

~~~
zepto
Sure, but over time that bridge can be improved.

------
mikelyons
In the future there'll be giant pipes of blood routed around the world that
are transparent and glow bright red or dark crimson, the arteries and veins of
the planet's Humanity Support System

farms of blob babies that we extract blood from in order to ensure our eternal
life

feeder bodies and then brains hooked up to the system, nobody will have a
body, bodies will be like cars, or absent entirely

there'll be a transition phase where people still live in their bodies and are
just doing blood changes like oil-changes, nightly while sleeping.

~~~
shawnz
You might be interested in Greg Egan's book Diaspora, which shows a view of a
possible future in which we are able to upload our brains to computers.

------
PHGamer
well yea it sucks right now but thats true for your body. literally if someone
turns the switch to your heart off your fucked. its just harder to carry
around an ecmo machine ;-). I hope we get artificial hearts some day. but oh
well.

------
jandrese
> hospital charged $4.2 million for a 60-day ECMO

Almost $3,000 an hour!

~~~
zrail
Not only is it a bed in one of the most expensive units in a hospital,
typically at a level 1 trauma center, but it’s also incredibly labor
intensive. Round the clock personal care by at least one nurse.

~~~
jandrese
The nurse's salary is probably less than $50/hour[1]. It's a small fraction of
the cost for operating this machine.

[1] [https://nurse.org/articles/highest-paying-states-for-
registe...](https://nurse.org/articles/highest-paying-states-for-registered-
nurses/)

~~~
walshemj
I would expect that a lot of the nurses in these sort of units are the higher
paid grades.

~~~
khuey
Even if the nurse is billed out at $500 an hour you're still only 1/6th of the
way to that price.

~~~
walshemj
A senior nurse plus all the supporting staff there will also be the on duty
doctors.

I have been in higher risk renal wards and there are lot of people about even
at night and that is a much lower risk ward.

I have also been in an ICU which has a lot more staff and I suspect that the
USA probably has a higher staff to patient ration than the NHS

------
drpgq
This seems like a future Black Mirror episode.

------
Scoundreller
How many years until I can swim in the sea/ocean without a mask?

~~~
teraflop
The solubility of oxygen in water just isn't high enough to make it practical
to extract enough oxygen for breathing. You would need something like 50
gallons per minute just to satisfy your basic resting metabolism, which in
turn would require a ton of power and/or surface area for gas exchange.
(Multiply that by a factor of 3 or 4 if you intend to actually do any
swimming.)

So you would have to bring a supply of oxygen gas with you, and at that point
you might as well get it into your body the old-fashioned way instead of
relying on a dangerous and fiddly ECMO machine.

