Covid patients pushed medical extremes in life support breakthrough

Victorian medical specialists have pushed an extreme form of life support — once considered a last-ditch bid — to bring Covid patients back from the brink.

Two senior Intensive Care Nurses in a life support training session.

Victorian hospitals have pushed the extremes of life support, saving dozens of Covid patients in months-long comas who would previously have been considered too far gone.

ECMO – or extracorporeal membrane oxygenation, the most extreme form of life support – is typically considered only for an average of fewer than 10 days, as a last-ditch treatment for critical ­patients.

But Victorian specialists stretched its use to up to 130 days and brought back 50 Covid-19 patients from the brink of death.

Details of the extraordinary intensive care effort are only now being revealed since the last long-term patients have left hospital after marathon periods on the ­machines.

By prolonging time on the lung-bypass machines and ­focusing their use to only the most experienced teams, The Alfred-led effort managed to save a remarkable 78 per cent of ECMO patients – more than halving the rates of death elsewhere around the world.

Survivor Stiven Taleski with girlfriend Monika Kostroman. Picture: Jake Nowakowski

Initial efforts to extend the brutal life-support techniques were debated even among Victoria’s specialists.

However, the Alfred’s head of ECMO Vincent Pellegrino said as the pandemic continued, and more patients emerged after spending an average of 41 days on machines, it was clear the unprecedented measures were working.

“We were flying into the unknown,” Professor Pellegrino told the Herald Sun.

“We didn’t know if all this work and suffering the patients were going through … we ­always had a concern in the back of their mind that we were putting people through things from which they might not ultimately benefit.

“In retrospect, I’m really proud of the way we fought on for as long as we did and saw really beneficial results.”

An ECMO machine at The Alfred Hospital.

ECMO takes over from a critically ill patient’s lungs and heart when their own organs cannot function to circulate blood through machines outside their bodies.

Around the world fewer than half the Covid patients placed on ECMO survived. In NSW, which had similar equipment, training and patient selection criteria to Victoria, the mortality rate with Covid patients was 51 per cent.

Using a tiered system in which almost all of Victoria’s 64 Covid ECMO patients were transferred to The Alfred or Geelong Hospital for often prolonged periods, specialists managed to save 50 patients and cut the mortality rate to just 22 per cent.

Frontline Covid Staff at Alfred Hospital on the helipad. Picture: David Caird

In one case a woman was kept on the life support machines for a staggering 130 days, while

Victoria’s first intensive care Delta patient has only recently left hospital following treatment that included 120 days on ECMO.

In another remarkable survival Truganina’s Stiven Taleski, 33, was sustained on ECMO for 84 days after his lungs disintegrated and surgeons had to repeatedly drain his chest of blood clots due to the most ­severe Covid complications.

“There was no way I was going to come out of it without ECMO. I would have been finished,” Mr Taleski told the Herald Sun.

Professor Pellegrino said after prolonging life-support care for the first patients and trawling international data, specialists detected a “mortality curve” kick in after 35 days, convincing them to stay the course and try to keep even the sickest patients alive.

“The motto we developed was just get us to 35 days,” he said. “By hook or by crook, get to 35 days and then we’ll see what happens. We only lost one patient out of 64 after 35 days. ECMO is limited in how long you can run it; we certainly extended it to the maximum.

“We had to wait it out in many cases. I know I’ve never seen anything like that before.”