ECMO treatment gives survivor time to heal
Machine that allows COVID patients’ lungs to improve is a ‘scarce resource’ at area hospitals
“ECMO just buys us time until the body can heal itself.”
Dr. Subhasis Chatterjee, Baylor St. Luke’s Hospital
For three months, Morgan Tate could see her mother only through a hospital room window. The 7-year-old could not go inside, so she wrote notes for the nurses at Memorial Hermann The Woodlands Medical Center to place by her unconscious mother’s bed.
In the child’s mind, her mother was sleeping. In reality, 41-yearold Michelle Tate was battling a devastating COVID infection that left her comatose and connected to a life-support machine called extracorporeal membrane oxygenation, or ECMO.
“She didn’t know how close I was to death,” Michelle Tate said.
The ECMO machine allowed Tate’s lungs to heal from May to July. Against the odds, she returned home in August. Her experience shows why ECMO machines have become an important tool for hospitals facing waves of COVID patients who need the highest levels of care.
Not everyone who needs the machine can get one. ECMO is a “scarce resource,” said Dr. Subhasis Chatterjee, director of the thoracic surgical intensive care unit and ECMO program at Baylor St. Luke's Hospital. There is a limited number of people who can safely operate the machine and care for the patients.
Baylor St. Luke’s has 12 total machines, 11 of which are being used. All four ECMO machines at Memorial Hermann The Woodlands are in use. About 7,600 COVID patients have initiated ECMO treatments worldwide within the last 90 days, including about 4,900 in North America, according to a registry maintained by the Extracorporeal Life Support Organization.
The machine drains blood from a vein in the patient’s groin area, before pumping the blood full of oxygen, removing carbon dioxide and returning it to the patient’s body through another vein, usually in the neck. By oxygenating the blood, ECMO does the lungs’ work, giving them time to recover from the long-term effects of COVID.
On ECMO, the lungs continue to pump 10-12 times per minute rather than 20-30 times. Through X-rays, doctors can see how the lungs heal over time and may make a decision to slow the ECMO support and return to ventilator-only support if they have recovered well enough, Chatterjee said.
The life-saving benefit of ECMO comes with consequences, said Dr. Daniel Kievlan, medical director of critical care at Memorial Hermann.
“(Tate) is not going to count as a mortality … but it’s going to have robbed her of months of normal living,” Kievlan said. “Even if you’re young and healthy, even if we can pull some
one through this with amazing efforts, your family can suffer from that. You can suffer longterm effects.”
Buying time
In the most severe COVID cases, ECMO is one of the last treatments to allow lung recovery before a person may need a lung transplant, said Chatterjee.
While the sickest patients on ventilators require oxygen to be delivered to their lungs at a high pressure, which Chatterjee said can cause further damage, ECMO bypasses patients' lungs completely, requiring a lower level of ventilation.
But the treatment is difficult on the body, and it doesn’t cure anything, he said. Blood thinners, used by every ECMO patient, can lead to bleeding complications and infections. About half of all COVID patients on ECMO die in the hospital, according to ELSO registry.
“ECMO just buys us time until the body can heal itself,” Chatterjee said. “ECMO is a bridge for the body to recover.”
Tate was still connected to the machine when she woke from her medically induced coma in July. She tugged on the tubes spilling from her body, not yet understanding they were keeping her alive. In her foggy state, she thought she was paralyzed forever. She could not speak and was too weak to handle a pen. She communicated using flash cards with basic words like “car” and “apple.”
COVID patients on ECMO typically remain paralyzed and sedated wihle they are intubated, allowing the machine to do the body’s work. But after 72 hours without fighting against gravity, a body’s muscle mass disappears, Kievlan said.
Tate’s ECMO treatment continued for months without any significant improvement in her oxygen levels.
“We had to get her up and moving,” he said.
‘A great spirit’
Tate managed to walk while connected to the machine — a first for Kievlan and his team. Kievlan hoped walking would strengthen her body enough to open her lungs. Partially numb and weakened from immobility, Tate said she “felt like Frankenstein” when a group of doctors guided her out of bed.
Over the next two weeks, Tate went from struggling to sit up to walking 100 feet.
“Michelle was absolutely amazing,” Kievlan said. “I’ve never had a patient with just the drive and incredible effort and rapid progressions she showed. She has a great spirit.”
A normal ECMO treatment should take less than three weeks, but COVID patients can take longer because of extensive damage to their lungs.
Younger people — those in their 30s, 40s and 50s — who are typically in good health perform better on ECMO, said Chatterjee. At his hospital, ECMO candidates usually do not include older patients or those whose other organs are dysfunctional because the survival rates are much lower.
“We would love to take care of everybody, but we are at our own maximum capacity,” he said.
Once a person is removed from the machine, recovery in the hospital can last several weeks followed by more rehabilitation.
Tate, a former Zumba instructor, lost 42 pounds during her hospital stay. She spent her final weeks in speech therapy and regaining her strength and mobility for day-to-day chores.
Now, she says the only lingering side effects are shortness of breath while climbing the stairs and minor aching in her joints. She is already hoping to return to Zumba by the end of the year.
‘Changed my life’
Many patients who require ECMO are not so fortunate.
Arturo “Hito” Bazan, a Houston police sergeant who supervises a narcotics squad, developed pulmonary fibrosis — a disease that occurs when lung tissue becomes damaged and scarred — after roughly two months on ECMO last year at Memorial Hermann The Woodlands.
Almost one year after his discharge, he still needs pulmonary rehab, which includes cardio exercises to build lung capacity. Portable oxygen remains a necessity as he regains enough strength to return to work.
Bazan tries to keep a positive outlook. He knows ECMO gave him a chance to live. He is grateful for the strong support of his wife and three children. But for a man with a previously active lifestyle — going to CrossFit, lifting weights, playing softball — he is constantly reminded of the virus’ physical and emotional toll.
“I’ve been in critical situations at work, and they never affected me like this did,” he said. “Because (the virus) is not something you can see. I thought I was being careful and it has changed my life in every aspect.”
For both Tate and Bazan, one of the most difficult parts of ECMO treatment was the separation from their children.
Bazan missed his daughter’s 16th birthday. His now 21-yearold son moved out of the house. His oldest son, now 23, graduated from Texas A&M University.
“As a parent, that’s what you look forward to and live for,” he said.
Tate wonders how the experience affected her daughter. Morgan fetched the neighbors when she saw Tate pass out in their Greenwood Forest home. She still calls for “Mom!” when she returns from school to make sure she is home.
“That’s the worst … having to worry about how long it’ll stay with her,” Tate said.
At the end of her hospital stay, Tate called Morgan every night to say her bedtime prayers with her. Tate promised that one day, she would be sitting on the couch waiting for her.
She kept her promise and surprised Morgan at home on Aug. 19. Tate cried the moment the child left the room.
“Maybe when she gets older and goes to college and gets married, maybe I’ll explain it to her then,” Tate said. “But now it has been all about protecting her, and just trying to normalize what she has seen so far.”