UNC Medical Center is treating severe COVID-19 cases with ECMO

There are encouraging signs about the recent wave of COVID-19. New cases in South Africa, where the Omicron variant of the coronavirus was first identified, have plummeted since late December, and the same is beginning to happen in parts of the United States.

But Katie Creran isn’t confident that an end to the pandemic is in sight. Creran is a Registered Nurse in the Surgical/Traumatic ICU at UNC Medical Center, where the critically ill COVID-19 patients are treated.

Here the patients receive the so-called ECMO or extracorporeal membrane oxygenation. They are heavily sedated and hooked up to ECMO machines that oxygenate their blood directly because the virus has damaged their lungs beyond the power of even mechanical ventilation.

ECMO patients need 24/7 attention from people like Creran, who has worked in this intensive care unit for the past six years. Like many caring for COVID-19 patients, she thought the arrival of vaccines last year would spell the end of the pandemic.

Then came a backlash to the vaccines, and vaccination rates stagnated. Less than half of adults age 18 and older in North Carolina are fully vaccinated and refreshed against the coronavirus, according to the state Department of Health and Human Services. Creran says she has “kind of given up” hope that the pandemic will end.

“Things might get better for a while and then a new variant comes out and we still don’t have the herd immunity that we need to keep people out of intensive care,” she said Thursday as she stood outside the room a COVID patient receiving ECMO. “I just hold my hope pretty close to my chest.”

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dr Lauren Raff listens to information from the team treating a COVID patient during morning rounds at the Surgical/Traumatic ICU at UNC Hospital in Chapel Hill, NC on Thursday, January 27, 2022. Scott Sharpe [email protected]

Where can I find ECMO treatment in NC?

ECMO is only available in large medical centers; In the Triangle, Duke and WakeMed also offer treatment for COVID-19.

UNC has one of the largest programs in the country, said Dr. Lauren Raff, a surgeon and trauma doctor on the team treating patients with ECMO. Before COVID-19, UNC used the procedure on heart and lung patients about two dozen times a year, Raff said.

Since the pandemic began in spring 2020, approximately 160 COVID-19 patients at UNC have required ECMO. At the peak of the Delta variant surge last summer, 13 of the 16 beds in the surgical/trauma intensive care unit were occupied by ECMO patients.

On Thursday, four patients in the intensive care unit received ECMO for COVID-19. Like those who came before, they had underlying health conditions like high blood pressure or diabetes that made them susceptible to the virus, and none of them had been vaccinated against the virus, Raff said.

While there are exceptions, it’s rare for a vaccinated patient to become ill enough to require a ventilator, let alone ECMO.

“Since the advent of the vaccine, it has been shown to be generally very safe and extremely effective in preventing severe COVID disease,” Raff said.

The Omicron variant has led to an increase in hospitalizations for COVID-19. A record 5,158 patients were reached nationwide on Thursday, according to DHHS. But in general, the variant causes less severe disease; less than 16% of those patients were hospitalized in intensive care units, compared with nearly a third during last summer’s delta surge.

The UNC Medical Center had 160 COVID-19 patients as of Thursday, including 25 who required critical care.

Raff knows of only two Omicron variant infected UNC patients who required ECMO; The rest of her ICU was hit by the Delta variant, which is still in circulation, she said. Doctors hope the spread of Omicron will further reduce the number of critically ill patients, Raff said.

“But the fear we have comes to Omicron,” she said. “As long as there is a large unvaccinated population, this virus can mutate and change very quickly and spread very quickly. That has been proven time and time again.”

Most COVID patients on ECMO will not survive

For COVID patients, ECMO is a last-line treatment. A patient can stay on the machine for anywhere from 10 days to seven weeks while their body tries to heal the damage to their lungs, Raff said. About 60% of ECMO patients don’t survive.

Creran said people who work in the ICU typically see “a decent amount of happy endings” when patients recover from surgery or trauma and go home. It’s hard to watch so many die from COVID-19, she said.

“We have to build a certain wall against these emotions,” she said. “We all have to find our own way of dealing with this and try to distance ourselves from it, unfortunately. For our own self-preservation only.”

When COVID-19 patients arrive in the intensive care unit, they are already heavily sedated and ventilated. If ECMO is successful, patients will still be sedated when they walk.

This means that Creran and her staff never see their COVID-19 patients while they are conscious. What they know about them comes only from medical records and information from family members who visit them.

Creran works three 12-hour shifts a week and often sees the same patient each time. She monitors her patient and the ECMO device almost constantly; makes sure food and liquids go in and urine and feces come out, all through hoses; moves the patient every two hours to avoid skin damage; and gives them a sponge bath once a day.

On Thursday morning, Raff, Creran, and half a dozen others associated with their patient crowded outside his room to review his progress and update their strategy. Raff suggested adjusting his sedation and considering another “trial” of reducing the amount of blood flowing through the ECMO machine to see if he’s getting enough oxygen on the ventilator alone.

A previous trial two days earlier showed he wasn’t ready.

The ongoing fight against the coronavirus is ‘frustrating’

Like many healthcare workers treating COVID-19 patients, Creran and Raff are disheartened that so many people distrust the science behind vaccines and refuse to get vaccinated.

“It’s frustrating to go around the world and be on social media and see that people don’t believe in it or are still hesitant,” Creran said.

Raff said not knowing when the pandemic will end has been taxing on doctors, nurses and other healthcare providers. It has to end at some point, she said.

“We hope it will be over soon,” she said. “Of course we’ll continue if not.”

This story was originally published January 28, 2022 8:40 am.

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Richard Stradling reports on transport for The News & Observer. Planes, trains and cars, plus ferries, bicycles, scooters and just walking. Also hospitals during the coronavirus outbreak. He has been a reporter or editor for 34 years, the last 22 of them with The N&O. 919-829-4739, [email protected]

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