2022 Critical Care Congress Plenary: What Has COVID-19 Taught Us About ECMO?

Peta M.A. Alexander, MBBS, FRACP, FCICM, understands that, as a critical care professional, she sees patients and their families on the worst days of their lives. As the medical lead for cardiac extracorporeal membrane oxygenation (ECMO) at Boston Children’s Hospital, she has always viewed her role as one of high regard and trustworthiness, and the facts bear that out. Medical doctors were considered the second most trustworthy profession in 2021, trailing only nurses in the annual Gallup honesty and ethics poll.¹
 
As the COVID-19 pandemic approaches its two-year anniversary and the politicization and selective reporting of facts related to COVID-19 and available therapies continues, Dr. Alexander worries that people are beginning to question the integrity of healthcare professionals. She is concerned not only about this change in attitude, she is even more alarmed by the impact it could have on the medical profession—on top of the realities of managing an ongoing pandemic.
 
Dr. Alexander will discuss this topic when she presents the Max Harry Weil Memorial Lecture titled, “What Has COVID-19 Taught Us About ECMO?” during SCCM’s 2022 Critical Care Congress. “Fatigue, frustration, and grief have wrought moral distress, burnout, and posttraumatic stress on our workforce at previously unrecognized rates,” she said. “Identification and deployment of strategies to promote healthcare professional recovery and reengagement will be essential to the ongoing availability of high-quality ECMO to the most critically ill in the community—during the evolving COVID-19 pandemic and beyond.”
 
The technologic advances that make ECMO possible are undisputed, Dr. Alexander said, but the effective use of ECMO is dependent on a skilled multiprofessional team of clinicians who have the ability to balance complex pathology with compassion and humanity. “No healthcare is delivered in a silo, nor is effective critical care delivered by any individual alone,” she said. “Successful ECMO support is resource intensive and only potentially of benefit when delivered at the right time, to the right patient, with all other aspects of critical care optimized.”
 
When multiprofessional teams work together, amazing things happen, Dr. Alexander said. Consider the multiprofessional management of congenital heart disease, a recent and rapidly evolving specialty. “Specialized cardiac critical care, with detailed knowledge of an individual patient’s congenital and palliated anatomy, attention to cardiopulmonary interactions, and pharmacologic interventions, has contributed to improved outcomes for these patients and continues to evolve alongside surgical and endovascular interventions,” she said. “There are now more adult survivors of congenital heart disease than infants and children who hold these diagnoses.”
 
Dr. Alexander looks at how those in the medical community have supported one another throughout the pandemic as another sign of what is possible with a strong, driven, and supportive team. “Critical care is changing rapidly,” she said. “The rapidity of vaccine and pharmacologic development, identification of inflammatory phenotypes, and the path to pathophysiology during the pandemic brought basic and translational science concepts to our attention. Despite all the critical care workforce has endured through the COVID-19 pandemic, there are some really exciting innovations that are gaining traction.”

References

1. Saad L. Military brass, judges among professions at new image lows. Gallup. January 2022. Accessed March 1, 2022. https://news.gallup.com/poll/388649/military-brass-judges-among-professions-new-image-lows.aspx