Extracorporeal membrane oxygenation (ECMO) is a machine that enables life support in vulnerable patients with severe and life-threatening diseases that prevent their heart and lungs from normal functioning. Patients who are connected to the ECMO machine need to use it for several days to several weeks, depending on the severity and progression of their condition. ECMO technology has found its application in the current Covid-19 pandemic. Thanks to this technology Acibadem Sistina Hospital recently saved the life of a 45-year-old patient in extremely serious health condition with quite progressed Covid-19 pneumonia. Acibadem Sistina Hospital has the most modern and up-to-date ECMO machine (Cardiohelp) operated by a highly qualified team of clinic perfusionists, cardiac anesthesiologists and cardiac surgeons with 20 years of extensive international experience.

Applying the ECMO machine is decided by a multidisciplinary team

“The ECMO machine is used for patients whose lungs do not provide sufficient blood oxygenation, despite the fact that extra oxygen is given, as well as in many other conditions when the lungs cannot remove carbon dioxide adequately even with the help of mechanical ventilation. Moreover, it is used in heart failure when the heart cannot pump enough blood into the body circulation. ECMO is also used as a bridge to heart and lung transplants whenever needed,” said Petar Trajkovski, clinical perfusionist from “Acibadem Sistina”.

Applying the ECMO machine in the treatment of Covid-19 patients is decided by a council of many specialists. In extremely serious situations when even the respirator cannot provide adequate body oxygenation, the ECMO machine is the only solution that can give a second life to the patient.

The ECMO machine adds oxygen and removes carbon dioxide from the blood

The ECMO machine is connected to the patient through plastic tubes (cannulas). The cannulas are placed in major arteries or veins depending on the ECMO procedure and the patient’s needs.

“The ECMO machine pumps blood from the patient to the artificial lung (oxygenator) where oxygen (O2) is added and carbon dioxide (CO2) is removed from the blood. Thus the machine replaces the lung function. Then the machine returns the blood back to the patient’s body using a pump with the same flow as the patient’s heart. So it replaces the heart function too”, said Sasho Stoilov, clinical perfusionist from “Acibadem Sistina”.

Each patient connected to the ECMO machine stays at Intensive Care Unit and is connected to a monitor. It monitors parameters such as ECG, central venous pressure (CVP), blood pressure, blood oxygenation level and carbon dioxide level. Gas analyses are performed periodically to determine whether adequate oxygenation and metabolic support are maintained. Besides, the patients are administered anticoagulants to prevent coagulation and thrombosis during the treatment.

Duration of the ECMO treatment depends on patient’s condition

The ECMO machine can prolong and save the patient’s life, but does not address the primary cause of heart or lung failure. The ECMO machine simply provides time and support as the multidisciplinary medical team works to correct and treat the primary cause. A typical example is the treatment of Covid-19 patients, when the patient’s lungs are unable to perform their primary function and the ECMO machine provides time to treat all systems in the patient’s body affected by Covid-19. Duration of the procedure depends directly on the progress in the lung recovery and it may last from a few days to a few weeks.

The latest data from world reference centers indicate that the ECMO machine provides a higher survival rate in life-threatening patients and those who do not respond to the usual method of life-saving treatments and therapies.

„“Acibadem Sistina” saved a Covid-19 patient applying ECMO technology

Acibadem Sistina Hospital is the first hospital in the country and the region that applying ECMO technology saved the life of a 45-year-old Covid-19 patient in extremely serious health condition of quite progressed Covid-19 pneumonia. The treatment of the patient involved a multidisciplinary team of doctors from Acibadem Sistina Hospital – Dr. Mitko Karagjozov, head of the Thoracic and Vascular Surgery Department, Prof. Dr. Aleksandar Nikolikj, head of the Cardiac Surgery Department, Dr. Dimche Slaveski, head of Cardiac Surgery Anesthesia and Intensive Care Unit, Petar Trajkoski and Sasho Stoilov, cardiac perfusionists, Dr. Nikola Shikov, head of General Intensive Care Unit and Dr. Patricija Kalamaras and Dr. Haralambos Sidiropoulos, infectious disease specialists. It is the first case in Macedonia to treat a Covid-19 patient by applying this technology. From now on this machine will be used in the treatment of other patients with severe complications caused by coronavirus infection.