ECMO, or extracorporeal membrane oxygenation, is an innovative medical device that helps save the lives of patients whose lungs or heart no longer function.
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Originally, it was designed to be used during surgeries as a temporary substitute to the patient's lungs or heart, but is available today in intensive care units, as well. In emergencies, it makes it possible to transfer a patient from one hospital to another.
Operating an ECMO machine is an undertaking that requires expertise, professional training, and manpower.
A single ECMO device costs $65,000 and an additional $3,000 every time a patient is connected to the machine. Moreover, each patient requires a nurse to supervise him or her alone. Therefore, while a regular ICU nurse can take responsibility for two patients, he or she can be assigned to only one ECMO patient. Of course, every such nurse requires special training.
Kaplan Medical Center in Rehovot has two ECMO machines, which in the current coronavirus infection wave have been lent out to Rambam Health Care Campus in Haifa and Shamir Medical Center in Beer Yaakov. Such medical equipment lending is common across hospitals in Israel, and can often help save the lives of patients in need.
Altogether, there are 82 ECMO machines in Israel. As per guidelines, each machine must have an additional device on standby. In Israel, about a third of devices are on standby. Currently [as of Thursday] 50 Israelis are connected to ECMO machines − 40 coronavirus patients, and 10 others.
Despite claims otherwise, Israel is fully committed to saving the lives of its citizens. Just to put it into perspective, Israel, with a population of only 9 million, has three times the number of ECMO machines that Britain, for example, does. In addition, 12 Israeli hospitals are qualified to use ECMOs, while in all of Britain there are only six.
Over 350 coronavirus patients have been treated with ECMO machines in Israel, and that is an incredibly high number. I would also like to point out that our expertise in operating ECMO machines led to us saving 50% of critically ill patients at the beginning of the pandemic. By now, that number has risen to 65%.
Therefore, Israel is fully invested in saving the lives of its citizens, much more than any other country in the world. This is also the goal of the Israeli ECMO society, which I have the honor to head.
Our goal is to help everyone and everywhere, so the state is currently working on training three more hospitals in the periphery to operate ECMO devices – in Nahariya, Ashkelon and Hadera.
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It is an initiative that requires a lot of training and resources, all for the sake of being able to transfer critically ill patients from the periphery to more central hospitals.
A person whose lungs have collapsed can survive for four hours without serious damage to his health. And yet, the state insists on training the healthcare staff at these locations.
I would also like to stress that ECMO machines are incredibly reliable devices. Air bubbles and blood clots are a possibility, but that is why there is a nurse supervising the patient at all times. Let's not forget, there is a backup device on standby if needed.
ECMO engines and systems are also reliable. One such device has been used in Israel for 20 years, and has only recently given out, years after its warranty expired. Meanwhile, it helped save countless lives.
Dr. Yigal Kassif is the head of Israel's ECMO society and a cardiac surgeon and director of ECMO service at Sheba Medical Center in Ramat Gan.
