When a ventilator isn’t enough: Why younger COVID-19 patients can need artificial lungs

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The patient has a full head of thick black hair. His face appears to be wrinkle-free. While it’s hard to tell how old he is, it’s obvious he isn’t old.

Yet the Ontario man in the University Health Network video is hooked up to a machine that’s doing the work of his lungs, which are severely damaged by COVID-19. A ventilator wasn’t enough for him.

ECMO (extracorporeal membrane oxygenation) isn’t new technology, but the type of patient it’s supporting has never been seen before.

“Especially in this third wave (of the COVID-19 pandemic), we’re seeing a lot more younger patients,” Dr. Marcelo Cypel, surgical director of the UHN ECLS program, told Global News.

“Many of these young patients with very severe lung disease… the ECMO device, it can be lifesaving.”

ECMO machines, also known as artificial lungs, take some of the patient’s blood, add oxygen and remove carbon dioxide, then pump it back into the body.

“(ECMO) allows us to rest the lungs and it buys us time for the treatments to work and allow the lungs to heal,” said Dr. Faizan Amin.

The medical director of Hamilton Health Sciences’ ECMO program says the procedure requires large tubes in a patient’s blood vessels, blood-thinning drugs and antibiotics. The risk of bleeding, blood clots and infection can be high.

That’s why ECMO generally isn’t used for seniors — they can’t survive it.

“People that are older and have other medical problems often can’t even tolerate the stress of going onto the machine,” said Amin.

“So we usually reserve (ECMO) for people that have been mostly healthy and younger before getting sick with COVID.”

Dr. Gurmeet Singh of the Mazankowski Alberta Heart Institute says the treatment is a last resort.

“ECMO is provided to the sickest of the sick. It is the most advanced life support that we have,” said the medical director of the Mazankowski’s adult ECMO program.

Singh says it’s normally used for severely ill cardiac or transplant patients, but his team has opted to use ECMO for younger COVID-19 patients.

“They’re more severely ill, they’re rapidly deteriorating and they’re not supportable with typical forms of life support.”

READ MORE: ‘Hit the hardest’: Why COVID-19 cases are rising among young Canadians

According to a 2015 study, about 40 intensive care units in Canada can provide ECMO.

At the moment, at least two patients in Alberta are using the technology. In Ontario, there are at least a dozen.

Amin says Hamilton Health Sciences has already borrowed four machines from the federal government’s emergency stock.

“We’ve had to add more supplies, more equipment, train a lot of our staff that weren’t previously trained — all in a pinch — within the storm that we’re in,” Amin said.

“It’s not what any of us had ever thought we would ever live through.”

Each ECMO patient requires at least one or two dedicated nurses, along with perfusionists, surgeons, respiratory therapists and anesthesiologists.

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