Hey Drew, Those ECMO machines are at best 2-3% of total ICU capacity. Some hospitals may have two, some have none. Your friend’ brother got assigned through some combination of grace and blind luck, and some level of battlefield triage (his relative odds of survival).
Some months ago, as Ontario’s third wave loomed, the OMA (Ontario Medical Association) issued a guidance to doctors on triaging patients if resources should become the limiting and therefore deciding factor on who is given lifesaving acute care. They were concerned that doctors were not trained to deal with the mental stress of having to chose who lives right now. They weren’t talking about sober decisions about reasonable means, or efficaciousness. They were talking about scarcity: you can’t save both patients ‘cause you only have one ventilator left… someone then has to tell the unlucky party, I’m sorry but we’re not treating you… Doctors are trained to triage on the basis of most critical need first, and the OMA was worried that they would have to start deciding (on the spot) who they could stand a better chance of saving and who they would simply have to turn away from treatment. Options included assigning someone to take the decision out of the doctors’ hands and even simply choosing at random. At one point Ontario reached 1600 patients of 2300 total ICU bed capacity. We never got to the point where ICU space was being assigned on a battlefield model, but we got there with ECMO circuits.
There may be 70 ECMO suites in the whole province. People could be (and were) disqualified as candidates based on age, underlying health conditions, and length of time already spent on a ventilator. I know one family that didn’t get the same chance we got.
At the peak of the third wave, the 12 ECMO suites in Canada’s largest Children’s hospital all had adults with COVID on them, just across the street from my wife’s hospital, with some staff pulling double duty at both locations. I was lucky enough to live within 40 minutes of approx 2/3rds of the province’s capacity. There’s a chance we got that bed just because we were an hour closer than someone else…
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