Northwestern Medicine doctors turn to rare treatment for COVID-19 patient with few options left

Medical Watch

CHICAGO — Doctors at Northwestern Medicine have turned to a rare treatment to save a woman when a ventilator wasn’t enough.

Extracorporeal membrane oxygenation machines, also known as ECMO machines, remove Carbon dioxide and infuses the blood with oxygen. Then it does the work of the heart and pumps the blood back into the body — giving both the lungs and the heart a break.

“ECMO can provide the lung support and heart support in patients who are critically ill and in patients who require mechanical ventilation but that is not enough,” said Dr. Ankit Bharat, Northwestern Medicine Chief of Thoracic Surgery.
 
In March, Dr. Bharat received a call that a critically ill COVID-19 patient, whose blood-oxygen levels had dropped to life-threatening levels, was not improving despite being on a ventilator. Dr. Bharat, who typically performs lung transplants, said it was the first time he considered using ECMO on a COVID-19 patient, but he knew it was the patient’s last chance for survival.
 
“They tried all the meds being proposed to treat this — all of these were given to the patient,” he said.
 
Dr. Bharat and his team travelled 50 miles to a McHenry hospital in a specially-equipped ambulance. Once they arrived, they began the bedside process to connect the patient to the ECMO machine before transferring her to Northwestern Memorial Hospital in Chicago.
 
“When you put someone on ECMO, you can completely replace their lung function so now you don’t need that level of mechanical ventilation support and in some, you can even separate them from mechanical ventilator,” said Dr. Bharat.

ECMO does not require sedation compared to mechanical ventilation, but patients need to be otherwise healthy — not in organ failure or obese.

The machines are not readily available. It’s estimated there is one ECMO machine for every 50 to 100 ventilators.

At Northwestern, Dr. Bharat said they have the ability to place about 20 patients on ECMO machines, but can build more using parts from other devices they have on hand.

While the treatment could be life-saving for some, it may not be readily available.
 
“The ECMO is definitely much more resource intensive. It requires a much more sophisticated set up,” said Dr. Bharat. “Its not available like mechanical ventilation at every place and if it’s not done in a proper manner it could be very harmful to the patient, so it’s not just a matter of putting someone on ECMO for the minute to minute care of these patients is quite intensive.”

After spending 11 days on an ECMO machine and several more in the ICU, the McHenry patient is now at home.
 
“She’s actually home now, breathing normal room air. She would not be alive without ECMO and coming here,” said Dr. Bharat.

Since March, Dr. Bharat said the team at Northwestern has used ECMO on six other patients with good results in all but one who had an unrelated complication.

The FDA released guidelines approving ECMO for COVID-19 patients and is allowing doctors to use modified cardiac bypass machines if necessary.

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