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Re:ECMO pumps blood out of the body, oxygenates it and retur... by whatshisface on Thursday June 20, 2019 @04:50PM (#20237225)
If it happened to someone like Bill Gates, maybe they'd decide to stay on it until somebody invented a portable version. Another interesting thought is that if the price of this thing falls a bit, there might be a few high-power professionals and executives who make more in an hour than the future ECMO costs to run. It doesn't look that big, maybe before long there will be a billionaire that travels around with a personal perfusionist wheeling an ECMO unit behind them. After that millionaires will start doing it, and in the end there will be affordable and entirely artificial respiratory systems.
Re:ECMO pumps blood out of the body, oxygenates it and retur... by jandrese on Thursday June 20, 2019 @05:18PM (#20237485)
I'm guessing the technology would need to improve a bit before that becomes a possibility. It needs to be made reliable enough to not require an operator monitoring it 24/7. Probably built into a wheelchair.

What would be really amazing is if we could replace defibrillators with these in stores, malls, etc... Instead of trying to restart someone's heart you have a system that's simple enough that a layperson can slap on a dying person to keep them alive while the ambulance arrives. Maybe in the form of a cuff that you clamp over someone's wrist that can use computer vision to identify veins and automatically insert the needles and run the machine. Too complex to be affordable with today's tech, but something that could definitely be possible in my lifetime I think.

Re:ECMO pumps blood out of the body, oxygenates it and retur... by mikecsh on Thursday June 20, 2019 @05:22PM (#20237523)
> Maybe in the form of a cuff that you clamp over someone's wrist that can use computer vision to identify veins and automatically insert the needles and run the machine.

There's a reason they put the lines in the femoral vessels - these cannulas are like hosepipes - you need to access the large vessels to get sufficient blood flow through the whole circulation.

Re:ECMO pumps blood out of the body, oxygenates it and retur... by Scoundreller on Thursday June 20, 2019 @06:03PM (#20237841)
But if you're going to have 1 machine, you need to build it big enough to get enough flow for recovery. And once you install that hosepipe, why bother changing.

The amount of flow needed to only sustain someone that hasn't been severely deoxygenated must be a lot less.

A smaller system might be able to initially infuse an oxygen-carrying booster (as Tour de France cyclists do) to get away with lower flow rates.

Re:ECMO pumps blood out of the body, oxygenates it and retur... by rscho on Thursday June 20, 2019 @06:55PM (#20238231)
Actually, reducing it much while keeping the current functioning principle would be difficult.

ECMO not only oxygenates, but pumps to assist the heart. Red blood cells would not resist infusion through small cannulas at high speed. Hemolysis already is a problem with the current size femoral cannulas.

So if what you're after is flow, size is a severe limitation.

Re:ECMO pumps blood out of the body, oxygenates it and retur... by mikecsh on Friday June 21, 2019 @03:37AM (#20240658)
Re:ECMO pumps blood out of the body, oxygenates it and retur... by rscho on Friday June 21, 2019 @04:57AM (#20240960)
Blood is non Newtonian. Poiseuilles doesn't really apply.

I'm aware that's what's taught in med school, though. At the maroscopic level, it works ok.

Re:ECMO pumps blood out of the body, oxygenates it and retur... by robocat on Friday June 21, 2019 @05:26PM (#20246430)
Remember that the system also needs to remove CO2.

Severe hypercapnia symptoms are bad.

Re:ECMO pumps blood out of the body, oxygenates it and retur... by flyGuyOnTheSly on Thursday June 20, 2019 @06:22PM (#20237995)
During a full on cardiac arrest, even getting a small trickle of oxygen to the brain for a few extra minutes can be life altering.
Re:ECMO pumps blood out of the body, oxygenates it and retur... by mikecsh on Friday June 21, 2019 @03:31AM (#20240635)
During a cardiac arrest the primary problem is a pump failure - blood is not flowing through the vasculature. A trickle of oxygen into the wrist will not help if the blood is not being circulated.
Re:ECMO pumps blood out of the body, oxygenates it and retur... by rscho on Thursday June 20, 2019 @06:44PM (#20238140)
Automated catheter insertion is one of those problems that seems simple to solve, but really isn't.

What you describe only exists in very limited form in research labs.

Re:ECMO pumps blood out of the body, oxygenates it and retur... by albertgoeswoof on Thursday June 20, 2019 @05:15PM (#20237457)
You think someone on ECMO is going to work?

Go take a look at an ICU ward, conscious or not these people are seriously unwell and as close to death as humanly possible.

Even the rich ones.

Re:ECMO pumps blood out of the body, oxygenates it and retur... by serf on Thursday June 20, 2019 @06:18PM (#20237964)
Yeah, except the kid mentioned in the parent article which divided clinicians as to whether or not their quality of life allowed for their decision to pull the plug.

He was 'seriously sick', but he had a certain quality of life that was unusual for ECMO patients.

...The boy was fully conscious, doing homework, texting friends and visiting with family. But after two months of living in the ICU, he was diagnosed with untreatable cancer that made him ineligible to receive new lungs.

Clinicians were deeply divided over what to do next, Truog said. Some wanted to stop ECMO immediately because its original goal — a bridge to transplantation — was no longer possible.

Others argued that even though he couldn’t survive outside the ICU, the boy seemed to have a good quality of life on ECMO, and his family and friends “derived benefits from his continued survival,” Truog wrote. They argued that the family should have the right to continue this form of life support, just as with dialysis, ventilation or an artificial heart.

A third argument arose, Truog said: If leaving this patient on ECMO was appropriate, then in fairness “why don’t we put everyone with respiratory failure on ECMO?”

For the parents, Truog said, it was “unbearable” to choose a day or moment to turn off ECMO, because they knew their child would immediately die.

Clinicians devised an alternative the family would agree to: They decided not to replace the ECMO oxygenator, a part that needs to be changed every week or two when it develops blood clots. After about a week, the oxygenator gradually failed and the patient lost consciousness and died, Truog said.

The solution “allowed him to die in a way where we didn’t feel like we were choosing the moment of his death,” he said....

Re:ECMO pumps blood out of the body, oxygenates it and retur... by JoshTriplett on Thursday June 20, 2019 @07:25PM (#20238469)
> A third argument arose, Truog said: If leaving this patient on ECMO was appropriate, then in fairness “why don’t we put everyone with respiratory failure on ECMO?”

That's not an argument against, that's an argument for. Why don't we? The only reason not to would be cost.

Re:ECMO pumps blood out of the body, oxygenates it and retur... by whatshisface on Thursday June 20, 2019 @05:22PM (#20237516)
The article said a teenager did his homework while on one.
Re:ECMO pumps blood out of the body, oxygenates it and retur... by pryce on Thursday June 20, 2019 @07:00PM (#20238267)
And if he decided not to do it, no one would mind. I say this as someone who has worked (briefly) in ICU, as well as having volunteered in a hospital school for two years, and (unfortunately) have had my own teenager in the ICU.

The difference we are talking about with work is that a person gets paid if they do work, and doesn't get paid if they don't.

When someone is unwell enough to be placed in an ICU, it is important not to be flippant about suggesting they do things for money. Even putting aside the ethics of it, or the fact that in some caees additional burdens could literally kill them, if you get your worker to give your company an extra few thousand dollars value and that worker ends up taking an extra day in the ICU, how much do you imagine that extra day of ICU treatment costs? And what sort of other costs might there be that aren't captured in dollars?

Re:ECMO pumps blood out of the body, oxygenates it and retur... by whatshisface on Thursday June 20, 2019 @07:30PM (#20238505)
You can't reasonably expect someone in the ER to work, but if your reasoning for unplugging them is cost, isn't working better than death?
Re:ECMO pumps blood out of the body, oxygenates it and retur... by snazz on Thursday June 20, 2019 @05:44PM (#20237697)
Re:ECMO pumps blood out of the body, oxygenates it and retur... by PhasmaFelis on Thursday June 20, 2019 @05:44PM (#20237699)
If you can get it down to the size of a purse, say, then you could go full cyberpunk. The patient has a convenient cavity in their chest that they're not using anymore...
Re:ECMO pumps blood out of the body, oxygenates it and retur... by taneq on Thursday June 20, 2019 @06:06PM (#20237865)
Might as well do the heart too, while you're there. And maybe add an SSD and some WiFi. And maybe a beefy arm.

Just whatever you do, make sure they did ask for it.