Demand grows for most advanced form of life support, as Alberta battles 3rd wave of COVID-19

Alberta’s third wave of COVID-19 is driving up demand for a form of life support that is considered a last line of defence.

ECMO (extracorporeal membrane oxygenation) can be used when a ventilator is no longer enough to keep a patient alive. It pumps blood outside of the body and through a heart and lung machine — adding oxygen and removing carbon dioxide — before returning it.

“We’re certainly seeing a great number of younger patients with more severe disease — more rapid deterioration —being referred for consideration for ECMO and that’s a concern,” said Dr. Gurmeet Singh, medical director of the adult ECMO program at the University of Alberta and the Mazankowski Alberta Heart Institute.

ECMO — which is used to give a patient’s lungs a chance to recover — is invasive and complex. It requires surgery to implant tubes, patients must be heavily sedated and placed on blood thinners, and it demands a high ratio of one-on-one care.

“The patients that we are choosing to rescue with this therapy typically have almost 100 per cent certainty of death otherwise,” said Singh.

Surge in Edmonton

Edmonton cardiologist and intensive care specialist Dr. Sean van Diepen has watched the B117 variant, which was first discovered in the U.K., entrench itself as the dominant strain in Alberta.

“The third wave is far more serious and people that look just like you and me are getting extremely sick with COVID-19,” he said.

“I’m getting a lot more … consults. My last two weeks of service are the most number of consults I’ve had for ECMO in my entire career. And that’s probably reflective of severity of illness.”

An ECMO machine, pictured here, pumps blood outside of the body, removing carbon dioxide and adding oxygen, before returning it. ECMO is used on a very small number of patients who are on a ventilator and are not expected to survive. (Alberta Health Services)

According to Alberta Health Services, 31 adult COVID-19 patients have been placed on ECMO since the start of the pandemic: 

  • Mazankowski Alberta Heart Institute has treated 19 COVID-19 patients with ECMO. Two remain on ECMO, six people have died and 11 survived.
  • Foothills Medical Centre has treated 12 COVID-19 patients with ECMO. Two remain on ECMO, nine patients have died and one survived

While ECMO is an option for some patients, it is by no means a routine therapy. According to the Public Health Agency of Canada, less than one per cent of all Canadians hospitalized with COVID-19 have received ECMO since March 2020.

 A team of physicians works together to decide if patients are strong enough to withstand the treatment, which can last for weeks. Factors considered include age, underlying health conditions, length of illness and potential for recovery.

According to van Diepen, some people are simply too sick for ECMO, including those who have permanent lung scarring and those with clots in the lungs, brain or heart.

“I find that I’ve had to turn down multiple people that are younger than I am, in fact. And that is quite disheartening.”

Doctors in Calgary prepare for uptick

 While doctors in Calgary aren’t yet seeing a dramatic surge in ECMO consultations, they are bracing for it.

“There certainly has been a small uptick in referrals,” said Dr. Ken Parhar, an intensive care physician at Foothills Medical Centre.

“But we are getting quite prepared for, over the next four to six weeks, potentially a significant increase just based on what we’ve seen in other areas across the country.”

While doctors prepare for the worst, they’re calling on Albertans to follow health guidelines and get vaccinated as soon as they’re eligible to avoid getting infected in the first place.

“The best thing of all is to avoid getting into our clutches,” said Singh.

“You don’t want to be a guest of ours, that’s for sure.”

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