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
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.
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.
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."
Thanks - so am I! I was quite impressed when I found out she had kept these notes, and given I was completely in a parallel universe with delirium during that whole time it helped join all the dots.
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
However, under a socialized healthcare system it's completely unlikely they would pay anything at all. That distinction probably saves lives on stress-relief alone.
^ This is the main point. I've heard people in the US say stuff like 'I'm one trip to the hospital away from bankruptcy', and I honestly couldn't bear living with that thought always in the back of my mind.
What if you fell ill and didn't want to become a burden for your family? Do you off yourself? Do you become the next Walter White? This is absurd.
Haven't done much research into that, so perhaps someone else did already - where was this tech invented and where this tech was implemented for the first time?
>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?
>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.
The tax payers. It's a government service, just like policing or firefighting.
> Why should a stranger be forced to pay for your medical care?
You may want to revisit this question if you ever find yourself in need of medical care. Ultimately, it boils down to which way you prefer to play the game of life - in a cooperative way, or dog-eats-dog, you against the whole world way?
>Why should a stranger be forced to pay for your medical care?
Those who don't want to pay for others usually leave for the US.
I've known Europeans or Indians too who think there are too many havenots in their country who will be dependent on state for their care and they knew who will foot the bill, so they left for the US.
There are all kind of people, some prefer private healthcare because they want to receive cutting edge treatment for all money they've and there are some who want to receive free treatment even if cutting edge treatment is not feasible for all of them.
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.
$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
Just want to say thank you for what you do. I spent a few days on ECMO in 2005 during the course of a double lung tx and saw some true heroics from the folks keeping me alive. It was a hell of an experience.
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.
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.
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.
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.
As a dialysis patient, I've read a lot about the technology and its history. Seeing the big bulky machines of the 70s that made people bedridden and prone to infections in a matter of weeks. With the advances of sealed disposable plastics it is possible to do dialysis at home. Recently they allow solo dialysis if the patient is comfortable. I happen to do PD dialysis every night when I sleep. During the day people don't notice anything different about me.
While it's clear ECMO is useful and sometimes lifesaving, I feel its constraints are underappreciated by the layman. Being on pump in itself is a major inflammatory trigger and is really, really not a walk in the park.
ECMO is one of my most dreaded things to be put on. The other being marrow transplant. I've seen things in ECMO that have nothing to envy to the goriest of B movies.
That said, it's true that things are improving. ECMO results are nowhere nearly as bad as they were just 10 years ago around here. Or so it seems to me, at least.
There are important distinctions between autologous (getting your Jen marrow back after ablation) and allogeneic (someone else’s cells) transplants.
The harvesting technique is now done using drugs like neupogen to mobilize the marrow stem cells into the blood stream where they can be collected in a process like dialysis. This is instead of having to actually extract marrow from the donor, which truly was barbaric, but I’m not sure if that’s done anymore.
The transplant process requires ablation (destroying the recipients existing cells) which I think can be done with chemo or radiation. It’s ~ a month in isolation to recover and the side effects of the ablation are also no fun but I’m not sure about “most dreaded”? There are probably some variations of the procedure which are much more difficult than others.
Even donation isn't particularly pleasant. From the documentation on my donor registry. "This is an inpatient procedure that will have a recovery period which will involve pain and discomfort." "Once the process has been started, can I change my mind? While legally you have the ability to withdraw consent at any point, as the recipient's immune system is extremely compromised and their own marrow is eradicated, you can be considered to have a moral obligation, as at that point, without your donation, the recipient will almost certainly die".
Marrow transplant is absolutely barbaric. Truly terrible. My daughter did it and I don’t feel like describing her discomfort but I’m sure there are some detailed stories that can be found elsewhere on the internet.
Graft-versus-host disease. I just want to mention most transplants aren't like below.
But imagine living your life in a small isolation room for weeks at a time. With infection over infection, bleeding out from every hole, and with good-intentioned people sticking needles into you all day long. Then you die alone in the ICU.
We used to joke that it'd be softer to die from the primary cause than from the treatment.
The cost is incredibly high and, if it becomes a bridge to nowhere, that incredibly high cost is paying for a terrible quality of life that will only get worse.
One of the patients in the story was a 17 year old with cystic fibrosis. Iirc, CF accounts for a third of all adult lung transplants in the US and half of all pediatric lung transplants in the US.
One drug for CF costs $250k to $300k annually. Patients who get a transplant go through around a million dollars worth of medical care in the year of the transplant. Following transplant, they have to add antirejection meds to their typically long list of other drugs.
Some years ago, some estimates put the treatment for CF at $100k to $250k annually. Some members of CF discussion groups would then wonder out loud "Where did they get these figures? They sound crazy low."
At the time, life expectancy for CF was 36 years old.
Around that time, one mom said "My child with CF just turned 18. When they were born, life expectancy for CF was 18. Now, it's 36."
People who get transplants can also go into rejection, which sound like a pretty gruesome death from what I have read.
The ethics of who get these kinds of treatments is really complicated. It does everyone a disservice to view it through rose tinted glasses. It's just not that simple.
Following your logic, why not just to euthanise CF patients?
India makes those $300000 drugs for a few dollars a pack.
There is nothing wrong with invasive medical procedures. At one point C-sections were "an extreme medical intervention against the will of god" and just any medication was "prolonging ones suffering"
If you can keep a man alive indefinitely with that, do so.
Such grim attitudes of people in US keep reminding me that USA was of few places in the world on boat with eugenics and fascism before the WW2
Following your logic, why not just to euthanise CF patients?
FYI: I and my oldest son both have a diagnosis of atypical CF. So you are flippantly suggesting I be murdered for being knowledgeable about my own diagnosis.
Suffice it to say that isn't remotely the point I was trying to make. I just get tired of the ridiculous drama when I try to talk about improving my diet, changing my lifestyle and getting off all the maintenance drugs. No one is at all interested in hearing about such an approach, presumably in part because there are no fortunes to be made off of it.
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.
> 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.
There's that, but in the mean time (especially at US cost levels), the additional marginal cost added to the health care system is likely to kill a number of other people with eminently TREATABLE conditions, e.g. because they need to gamble with their insulin supplies for cost reasons.
How the technology is viewed isn't the question, the question is how to most ethically administer this technology at the moment, with the medical interventions that are possible/reasonable.
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.
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.
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.
> 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.
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.
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.
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!
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.
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.
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?
Tens of thousands of people are in this very situation right now just in the US. They're on ventilators, but the scenario is the same.
Last summer a friend of mine had an accident while swimming at the beach, broke his neck, and spent six months on a a machine before he had a diaphragm pacemaker surgically installed. I visited him at a long-term care facility and there was a whole ward of people on ventilators.
I'm extremely grateful for the ability to breathe unassisted.
But how do they cope? I can't imagine sitting in a bed perfectly fine typing this post while hooked up to a machine keeping me alive and then doctors walking in and saying "It's time to discuss your end of life options."
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.
I'm guessing the technology would need to improve a bit before that becomes a possibility. It needs to be made reliable enough to not require an operator monitoring it 24/7. Probably built into a wheelchair.
What would be really amazing is if we could replace defibrillators with these in stores, malls, etc... Instead of trying to restart someone's heart you have a system that's simple enough that a layperson can slap on a dying person to keep them alive while the ambulance arrives. Maybe in the form of a cuff that you clamp over someone's wrist that can use computer vision to identify veins and automatically insert the needles and run the machine. Too complex to be affordable with today's tech, but something that could definitely be possible in my lifetime I think.
> Maybe in the form of a cuff that you clamp over someone's wrist that can use computer vision to identify veins and automatically insert the needles and run the machine.
There's a reason they put the lines in the femoral vessels - these cannulas are like hosepipes - you need to access the large vessels to get sufficient blood flow through the whole circulation.
But if you're going to have 1 machine, you need to build it big enough to get enough flow for recovery. And once you install that hosepipe, why bother changing.
The amount of flow needed to only sustain someone that hasn't been severely deoxygenated must be a lot less.
A smaller system might be able to initially infuse an oxygen-carrying booster (as Tour de France cyclists do) to get away with lower flow rates.
Actually, reducing it much while keeping the current functioning principle would be difficult.
ECMO not only oxygenates, but pumps to assist the heart. Red blood cells would not resist infusion through small cannulas at high speed. Hemolysis already is a problem with the current size femoral cannulas.
So if what you're after is flow, size is a severe limitation.
During a cardiac arrest the primary problem is a pump failure - blood is not flowing through the vasculature. A trickle of oxygen into the wrist will not help if the blood is not being circulated.
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....
> 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.
And if he decided not to do it, no one would mind. I say this as someone who has worked (briefly) in ICU, as well as having volunteered in a hospital school for two years, and (unfortunately) have had my own teenager in the ICU.
The difference we are talking about with work is that a person gets paid if they do work, and doesn't get paid if they don't.
When someone is unwell enough to be placed in an ICU, it is important not to be flippant about suggesting they do things for money. Even putting aside the ethics of it, or the fact that in some caees additional burdens could literally kill them, if you get your worker to give your company an extra few thousand dollars value and that worker ends up taking an extra day in the ICU, how much do you imagine that extra day of ICU treatment costs? And what sort of other costs might there be that aren't captured in dollars?
If you can get it down to the size of a purse, say, then you could go full cyberpunk. The patient has a convenient cavity in their chest that they're not using anymore...
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.
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).
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.
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.
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?
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.
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
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.
Disregarding ethical concerns, how challenging would it be to artificially provide signals to nerves going to the brain and get output through other nerves? With some kind of device like an ECMO connected directly to an extracted brain, the optical nerves connected to a computer somehow, and some fine motor control nerves connected back to the computer, a brain could operate completely outside of a body.
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.
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.
> According to this BBC article, the average cost of ECMO treatment in the UK is £45,000 per patient:
That appears to be a figure per course of treatment, not a figure per a day, so it isn't really directly comparable, unless we know the average duration of treatment as well (which is unlikely to be the same between US and UK)
For our daughter, there was a technician that literally sat next to the machine 24/7. There was never one moment without a technician there. Then there were all the other staff tending to her. The x-ray techs (2x daily x-rays), the respiratory techs, doctors, tons of other equipment and medicines. Our bill was just north of 600k for 10 days on ECMO, medevac, and 4 days in the NICU2 on a respirator.
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.
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
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.