Baystate using life-support machine to aid most severe COVID-19 patients

  • DR. DANIEL ENGELMAN

  • Workers construct a rapid response triage outside the Emergency Department at Baystate Health in Springfield in March 2020. STAFF FILE PHOTO

  • DR. ARMANDO PAEZ SUBMITTED PHOTO

Staff Writer
Published: 1/31/2022 7:33:34 PM
Modified: 1/31/2022 7:32:07 PM

A machine typically used for a few hours up to a few days for patients with life-threatening, heart-related conditions has been used recently for far greater lengths of time to support the recovery of COVID-19 patients.

“It is a last-chance option for COVID-19 patients in the intensive care unit (ICU) who have not responded to drugs and other treatments and who can no longer survive solely on a ventilator,” said cardiac surgeon Dr. Daniel Engelman, who also serves as cardiac surgical critical care medical director at Baystate Health. “Thanks to this advanced technology, 50% of patients who had no other hope of survival have survived.”

ECMO, which stands for extracorporeal membrane oxygenation, is a machine that replaces the function of the heart and lungs. It pumps and oxygenates a patient’s blood outside the body, allowing the heart and lungs to rest.

“Usually we use it to support both (heart and lungs) because we’re treating patients with heart failure and they require complete support,” Engelman explained.

With COVID-19, however, the machine has been used primarily for isolated respiratory failure. Depending on the severity of illness, patients can be supported for months.

“We’re lucky to have a mature program with trained specialists who can actually run this thing 24/7 and that everything was in place,” Engelman said, referring to the fact the program was first used at the hospital during the H1N1 influenza pandemic in 2009. “Because we had all the resources ready — not just the equipment, but the human resources — we were able to rapidly deploy the technology.”

Engelman said despite the damage caused by COVID-19, the machine has proven to be successful in half of all cases to allow the lungs to heal.

“Not back to normal,” he noted. “But enough to take them off the machine.”

At Baystate Medical Center in Springfield, the only Massachusetts hospital west of Boston to offer the procedure, a team of six cardiac surgeons is trained to place these critically ill patients on this device and manage their subsequent care, according to Baystate Health. Last year, 44 patients admitted to the hospital for COVID-19 were treated with help from the machine.

“The extreme majority of these patients were not only unboosted, but unvaccinated,” Engelman noted. “The few that were actually vaccinated had other comorbidities, such as being on chronic immunosuppressants, that put them at risk.”

He said the device, which has seen many iterations since it was first developed in the 1970s, has resulted in the heart surgery team taking care of the sickest COVID-19 patients in western Massachusetts.

“We never imagined it would be us … and yet it suddenly fell into our hands,” he said. “We had to make a lot of life and death decisions on the fly whether a patient was a candidate for this device.”

Still, Engelman thinks things are “looking up.”

“We’re hopeful,” he said.

According to the state Department of Public Health’s interactive dashboard, the seven-day average of hospitalizations in Massachusetts showed the start of a downward trend in mid-January, following a steady — and at times sharp — increase in the seven-day average of hospitalizations since July 2021.

“In the state of Massachusetts and at Baystate, the number of hospitalizations is trending down,” said Dr. Mark Tidswell, director of the Medical Intensive Care Unit at Baystate Medical Center. “For some time, we’ll have a large number of patients in the hospital as they continue to get better. It’s particularly the most severely ill patients who will take the longest to recover, so it could be a couple weeks before numbers — particularly the ICU numbers — go down.”

Hospital emergency departments have been “overwhelmed” by patients seeking testing or care for mild COVID-19 symptoms, according to Baystate Health.

Emergency treatment should be sought if an individual is experiencing difficulty breathing, persistent chest pain, inability to wake or stay awake, confusion, or bluish lips or face.

Meanwhile, for those experiencing mild symptoms, or simply looking for a COVID-19 test, testing sites can be found at mass.gov/GetTested. At-home tests are also available at pharmacies, and — given the virulence of the omicron variant — a positive test result on an at-home test should be treated as such.

According to the latest guidance from the Centers for Disease Control and Prevention (CDC), individuals who test positive for COVID-19 are recommended to isolate for five days, followed by five days of wearing a mask when in the presence of others. If an individual tests positive with symptoms, the isolation period starts with the onset of symptoms as “day zero.”

Isolation can end after five days if the individual is fever-free for 24 hours without fever-reducing medication and other symptoms have improved.

“It is also your responsibility to protect the health of others who do not live with you by telling those you have been in close contact with that you have COVID-19 or have been exposed to someone who has the coronavirus” Dr. Armando Paez, of Baystate Health, said in a recent statement.

Per the CDC, close contact means having been within 6 feet of someone for 15 minutes or more during a 24-hour period while contagious. An infected person can spread COVID-19 as early as two days before onset of symptoms or a positive test result.

“If you have been fully vaccinated with a booster shot for COVID-19, it is very likely that the symptoms you experience will be mild and that you will not require hospitalization,” Paez said.

He noted there are options for treatment for those who are at risk for severe illness, including the monoclonal antibody treatment, which is being administered several days a week outside of Greenfield’s Baystate Franklin Medical Center in Baystate Health’s Wellness on Wheels Bus. Certain oral medications also are available to eligible patients.

Paez echoed the words of his colleagues at Baystate Health, encouraging people to get vaccinated (and boosted) if they haven’t already.

“If you haven’t been vaccinated, get vaccinated as soon as possible after your isolation and recovery so we can get closer to ending this pandemic,” he said. “We know without a doubt that vaccination saves lives and reduces serious illness from COVID-19.”

Information on local vaccine clinics, as well as additional information on what to do if a test result comes back positive, can be found at FRCOG.org/COVID.

Upcoming mobile clinics

■Feb. 3, 1 to 6 p.m. — Mohawk Trail Regional School (Buckland)

■Feb. 11, 2 to 6 p.m. — Pioneer Valley Regional School (Northfield)

■Feb. 16, 2 to 6 p.m. — Jon Zon Community Center (Greenfield)

■Feb. 22, 2 to 6 p.m. — Franklin County Technical School (Montague)

Links to register can be found online at bit.ly/3rNd3rC.

Reporter Mary Byrne can be reached at mbyrne@recorder.com or 413-930-4429. Twitter: @MaryEByrne.


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