During the past century, cardiopulmonary resuscitative techniques such as CPR and AEDs have moved from the realm of science fiction to the standard of care. Today, we are seeing the same transition with another life-saving technology, extracorporeal membrane oxygenation (ECMO), says Brian Houston, M.D., an assistant professor and medical director of mechanical circulatory support at MUSC Health.
“Today, CPR is a standard of care for both in-hospital and out-of-hospital cardiac arrest. Similarly, automated external defibrillators, or AEDs, are also standard of care for out-of-hospital cardiac arrest. Even 30 years ago, that was science fiction, but now it’s the standard treatment for patients in cardiac arrest,” says Dr. Houston. “I think ECMO is right on the cusp of that transition as well.”
As doctors continue to debate how to best deploy ECMO and which patients would benefit most, one thing is clear: MUSC Health’s ECMO care team is expertly trained to use this technology—quickly, safely and nonsurgically.
What Is ECMO?
It’s helpful to compare ECMO to other cardiopulmonary resuscitation techniques, such as AEDs. An AED is a box designed to deliver electricity to the heart after cardiac arrest and get the heart back into a normal rhythm.
AEDs have been used outside the hospital environment with great success, says Dr. Houston. Multiple public health studies have shown that they:
- Are cost effective
- Save lives
- Contribute to improved out-of-hospital cardiac arrest survival rates
Except AEDs aren’t an effective treatment for all causes of cardiac arrest. Dr. Houston says, “Even if a patient has normal electrical activity or heart rhythm restored, they may not get blood flow back. Their heart may still not be functioning because something other than a heart rhythm problem caused their cardiac arrest.”
In comparison, ECMO is more comprehensive in how it treats cardiac arrest. ECMO takes over the function of the heart and lungs through large tubes, one inserted into a patient’s vein and one into the artery. An ECMO machine pulls blood out through the tube, pumps it back into the body and provides blood flow. This process oxygenates the blood by passing it over a membrane where oxygen is exchanged.
“You can have no lung or heart function, considered a complete cardiac standstill, and still have profusion of all your organs and be alive on an ECMO circuit,” says Dr. Houston.
ECMO was first deployed in 1972, born out of cardiopulmonary bypass technology, a machine that does the work of the heart and lungs during surgery. “Bypass technology is too large to be used long term, and it also has some long-term downsides. ECMO seeks to counteract those drawbacks,” explains Dr. Houston.
An ECMO machine is a small device, which makes it more portable. “The devices are now similar to the size of a lunchbox and can provide a pump and oxygenation device so that they’re more mobile,” says Dr. Houston. “We’re very much on the edge of ECMO technology right now.”
ECMO Benefits: Cardiac Arrest Survival vs. Cost
Compared to a decade ago, ECMO use has risen considerably. “In 2002, there were fewer than 400 cases of ECMO in the United States. In 2009 (the most recent data available), there were greater than 1,600 cases of ECMO use. So it’s more than quadrupled in 7 years, and I suspect those numbers have continued to rise in recent years,” says Dr. Houston.
Its benefits to patients are clear. Quite simply, this technology saves lives. “If you look at out-of-hospital cardiac arrest survival in the United States, it’s less than 8 percent. If someone experiences cardiac arrest on the street or inside their home, they have a less than 8 percent chance of being alive at 1 month.”
In comparison, when patients experiencing cardiac arrest were treated with ECMO, 40 out of 115 people in one study were alive at one year. That’s 35 percent of the participants compared to eight percent. “You’ve saved many more lives using ECMO,” says Dr. Houston.
“I think it’s hard to find any medical intervention that saves that many lives in that dire of a situation,” says Dr. Houston. “However, the flip side is looking at the 70 to 80 people who didn’t survive. They were still treated with ECMO, and ECMO is phenomenally expensive. The cost of any given ECMO run, from start to finish, is more than $300,000.”
Dr. Houston admits that while no doctor likes to think about cost, it’s a realistic piece of the public health conversation on how ECMO can best be implemented. “When we think about how to wisely use this technology as a community, we have to consider cost,” he says.
Another piece of that conversation is who benefits most from this technology. If doctors can better identify the patients who will benefit, the technology can save lives as well as costs.
Dr. Houston believes younger people who have a better chance of recovery might benefit from ECMO more than older patients with more concerning health complications.
Prompt, Expert ECMO Care at MUSC Health
Currently, only specialized ECMO centers can provide ECMO, due to the very intensive care patients require during ECMO treatment. MUSC Health is one such center.
“At MUSC, we have a highly trained group of profusionists and interventional cardiologists who specialize in ECMO,” explains Dr. Houston.
“Whereas in previous years ECMO used to require a surgical procedure, now it’s increasingly done by cardiologists through a catheter-based approach,” he continues. “This allows us to deploy it very rapidly, and our specialized team ensures expert post-deployment care, where we can expertly care for ECMO patients, from start to finish.”
To reach Dr. Houston, email firstname.lastname@example.org.