How the Texas Medical Center’s Extracorporeal Membrane Oxygenation Specialists Teamed Up to Save Lives During the COVID Crisis
From the early stages of the COVID-19 pandemic, critical care medicine professionals on clinical teams across the Texas Medical Center (TMC) collaborated to provide life-saving support to severely ill patients with the virus. The cooperating hospital systems recently published their experience with the use of extracorporeal membrane oxygenation (ECMO) in patients with respiratory failure due to COVID.
COVID-19’s deadliest effect on the human body is lung damage. Fatalities related to COVID often result from pneumonia and acute respiratory distress syndrome caused by the virus.
Patients with the most severe cases of COVID develop pulmonary failure to the point that they can no longer get enough oxygen even with mechanical ventilation. These patients’ best chance of survival is the use of ECMO: a technique of pumping blood out of the body, removing carbon dioxide, adding oxygen, and reinfusing the blood, essentially taking over the function of the lungs. This treatment requires specialized equipment and personnel with special training.
For this reason, the COVID-19 pandemic created a crisis in the Texas Medical Center. Many COVID patients came here for treatment, but only a few TMC hospitals were capable of providing ECMO.
To meet the needs of patients with severe COVID, ECMO specialists in the TMC’s three largest hospital systems—St. Luke’s, Houston Methodist, and Memorial Hermann—collaborated to ensure that all patients who needed ECMO could receive it. Dr. Subhasis Chatterjee, a cardiothoracic surgeon/intensivist with Baylor–St. Luke’s Medical Center and a member of The Texas Heart Institute’s Professional Staff, was one of the leaders of this effort.
“We had daily conference calls to ensure that all three institutions had enough beds, equipment, and staff to provide ECMO to every patient who needed it,” says Dr. Chatterjee. “If one hospital’s ECMO facilities were at capacity, patients could be directed to a different one. We also talked about selection criteria, techniques and strategies for cannulating patients, and the lessons we were learning as we went. Above all, this was a team effort at each center with nurses, perfusionists, intensivists, and the cardiologists and surgeons involved. We had to collaborate within our hospital and within the TMC.”
Between March 15 and May 30, 2020, the three major hospital systems used ECMO to support 35 patients with severe hypoxemic respiratory failure due to COVID. Twenty-three of these patients survived to hospital discharge, and all of them were still alive 1 year later. Of the 12 patients who did not survive to discharge, 9 died of multiorgan failure and vasoplegic shock, 2 died of stroke, and 1 patient with severe morbid obesity died of cannulation-related bleeding. These results were recently published in the ASAIO Journal.
“Given that these were the most desperately ill COVID patients, a sixty-six-percent survival rate is impressive,” Dr. Chatterjee says. “But I should add that these results were from the first wave of COVID. When the second wave came months later, driven largely by the Delta variant—which was even harder on the lungs—and affecting a lot more patients, ECMO patients had a much higher mortality rate. Nonetheless, our collaboration kept a lot of patients alive who might not have survived otherwise.”
Akkanti B, Suarez EE, O’Neil ER, Rali AS, Hussain R, Dinh K, Tuazon DM, MacGillivray TE, Diaz-Gomez JL, Simpson L, George JK, Kar B, Herlihy JP, Shafii AE, Gregoric ID, Masud F, Chatterjee S. Extracorporeal Membrane Oxygenation for COVID-19: Collaborative Experience from the Texas Medical Center in Houston with 2 Years Follow-Up. ASAIO J. 2022 Sep 23. doi: 10.1097/MAT.0000000000001791.
News Story By Stephen N. Palmer, PhD, ELS