ECMID (Covid ECMO): Who do You Pick?

Editor’s Note:

In this frenetic clinical environment we now live in- we are challenged by uncertain circumstances- with little to no virtual experience from which to draw upon.  All of us are at some point close to- if not in direct contact with a COVID-19 positive patient.  I’m sure we have all game played exposure to this virus in our own minds- but nothing really becomes serious until you are confronted with a VV ECMO on a virus positive patient.

Our group is in flux- so depending on the week, we may or may not have enough support personnel to deal with our routine clinical obligations if an ECMO is thrown into the mix.  This isn’t the case currently, but we do find ourselves stretched to max capacity, and had some decisions to make.

Upon hearing we had an ECMO coming up, being apprised of the fact that this was a “COVID Patient”, the first thing you have to consider is-

• • Who will set up and run the ECMO?
  • What are the risk factors to this clinician?
  • Do we limit exposure to one CCP?
  • Do all of us dive into the mix and risk the entire group being exposed and then possibly infected?

From my stand point it stands to reason that we limit exposure to one perfusionist.  So WHO gets to do it?

• • Our healthiest CCP is the youngest and the chief perfusionist.  She is also the individual upon whose shoulders this program rests.
    • Married. No children. Healthy.
  • The next CCP is a traveling perfusionist slightly on the other side of the curve when Age as a risk factor is considered.
    • Single. Adult children.  Healthy.
  • The other CCP is another traveler on the cusp of the front side of the curve when Age as a risk factor is considered.
    • Married. 5 Children. 1 adult child. Healthy.

In effect, the group has to be honest and self triage.  So everything comes to the foreground regarding risk, and the negative impact should infection and possible morbidity/mortality come to bear.

The primary questions to be considered:

• • Who is at greatest risk?
  • Which family is devastated the most should the person become infected?
  • Who is the most indispensable should they need to be quarantined (strongest v. weakest link) ?
  • What trumps what?  Life span left?  Family?  Children?  Skill set?

The question no one wants ask- Who is the most disposable?

The moral/ethical questions implied here are a hard thing to confront because of the fact that having a question like this arise to begin with suggests that you have to assign a judgement or place a value on one person’s life over another.  That’s clearly impossible and a dilemma- yet it remains a decision that has to be made.

In our particular case, our chief made a command decision and put the patient on ECMO.  This was discussed however prior to the decision being made.  But in all reality- she made the choice, and chose to take that risk onto herself.  Now that is very brave and that’s what a leader does.  But it painful because of course I am conflicted, but it is what it is for now- and that is what we signed up for.  Call it “pre-survivor guilt?”

I’m sure all of us will be part of this ECMO effort- so this is more of a heads up on questions that you will find yourself facing  should you encounter this situation.

Make no mistake about it.  COVID is certainly the real deal.

Any thoughts or comments are welcome

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I see a lot of you reading this 🙂

Be Safe!

Pump Strong-

Frank 🙂