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Results vary widely between hospitals. Overall, however, survival declined over time, including in the greater U.S. and Europe hospitals. According to the international registry, from January to May 2020, less than 40 percent of Covid patients died in the first 90 days after the initiation of ECMO. But in the months that followed, more than half died. Dr. “Patients appear to be in significantly worse condition,” Barbaro said.
He and colleagues are analyzing whether this is related to factors such as new virus variants, less experienced centers providing care, or changes in treatments patients received prior to ECMO.
Who can pay and who can’t
ECMO is offered at several community hospitals where most Americans receive care. An exception is Saint John’s, the Santa Monica facility where doctors and police sergeants receive treatment.
He started an ECMO program about a year before Covid-19 emerged. The 266-bed hospital has treated 52 Covid patients during the pandemic, and this is the same as the entire Northwell healthcare system in New York, with nearly 6,000 hospitals and long-term care beds.
Saint John’s charity, supported by the region’s rich donor base, helped fund the ECMO program and expansion. While the hospital admits some uninsured Covid patients for ECMO, these patients elsewhere often denied despite a federal program reimburses hospitals for their care.
Saint John’s ICU director Dr. “There’s a lot of inequality,” said Hammond. And for every Covid patient surviving with ECMO, there are “probably three, four, five. die on the waiting list”
He and other doctors said the outbreak highlighted the need to make ECMO more widely available and less resource-intensive. Until then, “we really need a sharing system,” he said. Allocation systems exist for transplant organs and trauma care.
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