Fundamentally ECMO is a life support machine that is called on when people are dying and specialist staff are in need of more time to fix the problem. In severe Sepsis cases it is often in the presence of extremity shutdown, arms/legs mottling and dying in front of your eyes (thats why you see lots on amputations as a consequence of Sepsis). It’s ICUs last resort in having more time to find the actual infection/cause of the poisoning to treat the cause.
During the treatment of a possible Sepsis prognosis, hospitals (Sepsis 6 pathway – https://sepsistrust.org/…/2…/06/ED-adult-NICE-Final-1107.pdf) take blood cultures (blood taken from the body to send to the blood testing lab) BUT it takes up to 3 days to find the specific cause of the lactic acid/poisoning to accurately treat with an appropriate Antibiotic to kill the cause, but when in sever sepsis (the next stage of body shutting down or causing inflammation to organs as a consequence of the poisoning) we simply do not have 3 days to wait.
ECMO machines (and specialist staff/team) are used to rest the lungs and heart when they are working overtime to try and keep the body alive from the infection. The body is struggling to do the right thing and in Sever Sepsis (Sepsis shock) cases it (the body) gets it all wrong and causes inflammation and damages to the organs it is fundamentally trying to save. Basically the bodies reactions tries to survive but gets it all wrong and damages more than it can save. The brain has mis-wired and in what it thinks is helping to fight the infection it is actually damaging the organs/body.
An ECMO machine/staffing takes blood from the arteries, removes the lactic acid (the poison that is flowing through the body), oxygenates the blood (relieves the pressure on lungs to pump oxygenated blood) and relieves the pressure on the heart to pump more blood to get clean oxygenated blood to the “whole” body, particularly extremities, which is a normal body reaction to shutdown things furthest from the heart first by trying to survive.
What is the difference from septicemia, blood poisoning and Sepsis?
Ok this is where terms like sepsis, blood poisoning and Septicemia gets very confused and cross used.
Septicemia (blood poisoning) is a bacterial infection that spreads into the bloodstream. Sepsis is the body’s response to that infection, during which the immune system will trigger extreme and potentially dangerous, whole-body inflammation. Sever Sepsis is where the imune system is killing the organs (for want of a better term) and it is classed as life threatening.
Why is SEPSIS only now being heard of?
Now this is the controversial bit.
There is a thing called ICD coding. It’s a code that is allocated to the cause of death. It was very easy to classify a sudden heart or kidney failure (for example) as a cause of death when it was actually sepsis as the infection caused the death. Fundamentally organ failure WITH a bacterial infection should be classified as SEPSIS. In the UK we are lucky that we have implemented correct patient pathways and now are are reporting effectively. Could also go into overuse of Antibiotics and hygene but thats for another day.
Why was it important to Lucy?
On that Tuesday when lucy arrested (heart stopped) there was still confusion on WHY? She had an internal inspection on her bowels (apparently a common cause of sepsis) but every examination (20 consultants) showed no reason for the poisoning. To this day (I phoned the coroner last week and they still do not know why) we do not know what infection caused the sepsis.
A local ECMO would have given our situation more time to find the cause of the infection and obviously fix it.
A 3 hour wait for such a machine (to extend the time to find the cause) was too long and Lucy passed away.
A local ECMO machine/facility would have given the surgical team more time to find the CAUSE of the infection and corrected her bodies responce of septic poisoning.
What are we fighting for?
An ECMO facility within an hour of every patient in the UK. Simple. If not Wales then definitely the South West of UK! (Drawing circles around every town that does not have such a facility within an hour and raising awareness) If the Welsh government do not agree (research doc underway) that it is not viable then I will be focusing on the UK parliament to make the change.
So the question on everyone lips is… how much is it?
The straight answer is I don’t know. Yes I know the machine costs around £40,000 but how many consultants and nurses are needed, I do not know.
I also haven’t found the strength (yet) to visit a facility to ask the question and it’s only been 5 months since we lost Lucy. BUT I will get this information as I say when I build the strength to take it to the next level.