An “artificial lung” to save lives

Un «poumon artificiel» pour sauver des vies

Photo: Getty Images/iStock
In normal times, the oxygenator extracorporeal membrane is especially used during surgery or heart transplants heart and lung, ” says Dr. Simon.

It is an “artificial lung” the size of a large coffee maker. It can save the sick in the thirty hit hard by the COVID-19. In Japan, China and South Korea, the oxygenator extracorporeal membrane (commonly called ECMO) is an integral part of the arsenal of doctors to treat younger patients. And in Quebec ?

Last week, the Montreal heart Institute and the university Institute of cardiology and respirology of Quebec, have each ordered an oxygenator extracorporeal membrane, to an amount totaling $ 420 000 $, indicates the electronic system of call for tenders by the government of Quebec. The contract was concluded otc, because of the present emergency.

Since the beginning of the pandemic, the planet is stripped of the appliances. “We don’t know when the LCS is going to happen,” says pulmonologist Matthew Simon, head of the intensive care unit of the university Institute of cardiology and respirology of Quebec.

In normal times, the oxygenator extracorporeal membrane is especially used during surgery or heart transplants heart and lung, ” says Dr. Simon.

During the procedure, the patient’s blood is sent to the outside of the body to an ” artificial lung “, where it is supplied with oxygen. It is then redirected into the body through a pump external. The heart and the lungs then have a respite.

Two weeks ago, the canadian Society of cardiology (CSC) is concerned by the limited number of ECMO in Canada, given the current pandemic.

The device is useful not only for patients with problems of cardio-respiratory, but also for patients with acute respiratory failure, ” notes the CSC in a letter sent to Ottawa and made public on its Web site.

During the H1N1 pandemic, in 2009, of patients in a critical state have benefited from ECMO, adds the CSC. Countries use it to treat patients infected by the COVID-19.

A effectiveness not demonstrated

In Quebec, the health network has 66 oxygenators extracorporeal membrane according to the ministry of Health and social Services (MSSS). It is reminiscent of the MSSS, a ” device ultra-specialized “.

According to the ministerial sub-committee COVID-19 critical care, ECMO should be preventable”, in the “great majority” of cases of acute respiratory distress syndrome related to the COVID-19, ” especially in the context of pandemic “. The decision to use ” should be the subject of a consensus service (not individual decision) “, he wrote in the Guide to procedures and techniques in intensive care and emergency COVID-19, intended for health professionals.

Dr. Antoine Delage, president of the Association of lung specialists in the province of Quebec, sits on this sub-committee. It stresses, in interview, that the ” benefit is not clear “.

“It is a therapy of last resort,” he said. We do not expect that a lot of patients in need of ECMO and can take advantage of. “

Too few data exist to demonstrate its efficacy in the treatment of the COVID-19, according to Dr. Simon. But in the case of diseases that are similar to the COVID-19, as severe pneumonia related to flu, “young well selected patients” have been able to get by thanks to the ECMO, he says.

Yes, we want to do everything to ensure the survival of all the world, but resources are limited

— Mathieu Simon

 

Until now, no patient quebec reached COVID-19 was connected to an ECMO, according to Dr. Simon. Patients under the age of 60 years have, however, been put under a result, artificial respirators, according to doctors contacted by The Duty.

The technique of ECMO is expensive. “It requires a lot of resources,” said Dr. Simon. A nurse and one perfusionist must remain at the bedside of the patient. “In a pandemic situation, it may be better to assign these two professionals to other patients ? he asks. “Yes, we want to do everything to ensure the survival of all the world, but resources are limited “, said Dr. Simon.

Why buy two LCS, which are worth hundreds of thousands of dollars, then ? “If the epidemic is less great, and [that more professionals are available], it would be unfortunate to let a father of 40 years to die because we don’t have the machine that can save him,” says Dr. Simon. In the region of Quebec, a pregnant woman, struck by lightning by the flu, gave birth in ECMO in 2018. The mother and the baby had no ill effects.

But the LCS is not a miracle cure. A patient on two, connected to this unit, comes out of it, ” said Dr. Simon. Without ECMO, they were heading towards a death ensured.

 

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