Israel is buying more heart-and-lung ECMO machines as the number of serious COVID patients hooked up to them reaches new highs, with four such devices recently arriving and six more expected soon.
As of Thursday, 58 patients were connected to ECMO machines, but the number eased to 56 Friday morning, compared with 43 at the peak of the previous COVID waves. Another eight patients with other illnesses are on the devices, causing a need for more.
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“For a few hours Thursday, not a single ECMO machine was available in all of Israel. This changed after one patient died and a broken machine was fixed,” said cardiac surgeon Yigal Kassif, the director of ECMO services at Sheba Medical Center and the head of Israel’s ECMO society.
“Now the situation is better. But yesterday I was forced to announce in the ECMO staff WhatsApp group that anyone who now connects a patient to an ECMO has no backup.”
Even though the number of seriously ill patients is dropping, the number of COVID patients on ECMO machines has risen, at least until Friday. Of the 56 COVID patients now hooked up to these machines, 50 – or 90 percent – are unvaccinated. Three were in the process of vaccination and three had received two doses but not the booster.
Forty-two of the 56 COVID patients were between 40 and 60 years old and 10 were under 40 – including two women who had given birth. Two were under 18.
During the coronavirus crisis, Israel has expanded its number of ECMO machines to 82 from 35, while 1,200 staff members – mostly nurses – have undergone ECMO training. But a third of the devices are supposed to serve as backup in case machines break down.
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Ten newly purchased machines will raise the number of ECMOs in Israel to 92, a number that is supposed to cover treatment and backup based on the number of patients today.
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.
“We’re moving patients and devices to provide the best response, but for eight hours on the night between Wednesday and Thursday we were left with just 17 backup machines,” Kassif said.
“Since then, a few more available machines were added because of patients who recovered or died, and every machine was fixed and put back in service. We hope we’ve reached the peak and will begin to see a drop.”
In earlier waves, the number of patients in serious condition peaked at 1,200 in Israel, with the number of patients on ECMO machines topping out at 43. Now those numbers are 460 and 56 respectively.
Kassif says there is no clear explanation for the record number of patients on ECMO machines; he says the culprit could be the delta variant, which has caused more severe infection among the unvaccinated.
“It’s possible that since we’re saving two-thirds of those on ECMO machines, we can connect patients at an earlier stage than in the past in the hope of saving patients we couldn’t save before, but we have no certain clinical or scientific explanation,” Kassif said.
“We know that, just as with patients in serious condition, the peak comes a certain amount of time after the rise in the number of infections, and here too the ECMO peak comes later. I want to hope that it’s behind us, but I’ve been wrong the last two times.”