Israel Reaches Record Number of COVID Patients on Life-saving ECMO Machines

Currently 45 COVID patients are on the devices, but not a single one received all three vaccinations. With a total of 82 ECMOs, and one-third earmarked as backups for malfunctions, a shortfall is possible

Ido Efrati
Ido Efrati
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A patient connected to an ECMO machine at Shaare Zedek Medical Center, on Thursday.
A patient connected to an ECMO machine at Shaare Zedek Medical Center, on Thursday.Credit: Ohad Zwigenberg
Ido Efrati
Ido Efrati

As many as 46 coronavirus patients were on heart-and-lung ECMO machines as of Sunday, the highest number on the apparatus in Israel during the pandemic – and a figure that one doctor says is putting the country near the breaking point.

The number of these patients, who are in critical condition, eased to 45 in the morning when one patient’s condition improved.

Six patients with other illnesses are also on the machines, putting the overall number at 51. Israel has a total of 82 ECMOs, a third of which are intended as backup in case of malfunctions.

As a result, only a handful of machines are available at hospitals for new patients. At the height of the pandemic’s third wave in January, 43 coronavirus patients were on the devices.

No one who has received all three doses of the coronavirus vaccine is on an ECMO machine.

Of the patients on an ECMO, 40 of 45, or 89 percent, are unvaccinated, and the other five received two doses or were in the process of being vaccinated.

Thirty-two of the patients are between 40 and 50 years old, seven are between 18 and 40, and six are over 60. Three are women who recently gave birth.

Dr. Yigal Kassif, a cardiac surgeon, is director of ECMO services at Sheba Medical Center near Tel Aviv and the chairman of the Israel ECMO Society. He said the ECMO system is approaching a breaking point and that it’s impossible to predict the exact number of patients that will put Israel there.

The scarcity of the machines is forcing hospitals to prioritize certain patients.

“Prioritization sounds like a lethal word, but we prioritize all the time when we reach a lack of resources, whether it’s in a mass-casualty incident or when a 90-year-old arrives and we don’t have an intensive-care bed,” Kassif said.

“So yes, we’re avoiding hooking up to an ECMO machine a patient whose chances of survival are below 10 percent, though maybe we would have connected him if he was the only one in the country who needed an ECMO.”

An ECMO machine substitutes for the heart and lungs. It draws the patient’s blood through tubes inserted in veins in the neck or groin; the blood then reaches the heart’s right atrium. The blood pumped from the body is then sent to the device, which uses a membrane called an “artificial lung,” where it absorbs oxygen.

After that, the blood is returned to the body and carries the oxygen to cells. This process can go on for weeks.

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