The rationing of a Covid treatment of last resort


Results vary widely from hospital to hospital. Overall, however, survival has declined over time, including in major US and European hospitals. From January to May 2020, according to the international registry, less than 40% of Covid patients died within 90 days of the onset of ECMO. But in the months that followed, more than half died. “The patients seem to be doing significantly worse,” said Dr Barbaro.

He and his colleagues are analyzing whether this is related to factors such as new viral variants, less experienced healthcare facilities, or changes in the treatments patients receive before ECMO.

ECMO is offered in a few community hospitals, where most Americans receive care. Saint John’s, the Santa Monica facility where the doctor and police sergeant received treatment, is an exception.

It started an ECMO program about a year before the emergence of Covid-19. The 266-bed hospital provided therapy to 52 Covid patients during the pandemic, roughly the same as the entire health system from Northwell to New York, which has more than 6,000 hospital and care beds long term.

The Saint John’s Charitable Foundation, supported by the region’s rich donor base, helped fund the ECMO program and its expansion. The hospital has accepted some Covid patients who are uninsured for ECMO, while elsewhere these patients have often been refused despite a federal program that reimburses hospitals for their care.

“There are so many inequities,” said Dr. Hammond, director of the Saint John ICU. And for every Covid patient who has survived with ECMO, there are “probably three, four, five people dying on the waiting list.”

She and other doctors said the pandemic had highlighted the need to make ECMO more widely available and less resource-intensive. Until then, “we really need a sharing system,” she said. Allocation systems exist for organ transplants and trauma care.

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