ECMO Can Save Lives. It Can Also Become A 'bridge To Nowhere.'

Your Choice Regarding Extending Session on this Site

You may be receiving this error message if you are logged out. Be sure to log into your account to access the resources.

Auto logout in seconds.

Continue Logout

Today's Updates

• Report

  12 things CEOs need to know in 2026

• Recently Updated

  Healthcare Policy Updates Timeline

• Podcast

  Ep. 286: A Medicare Advantage reset — and what comes next

• Webinar

  [March 5] Medicare Advantage: Insights on today’s more competitive market

• Daily Briefing

  Join 165,000+ healthcare leaders and get the industry’s most important news in your inbox—every day.

Previous news Next news

• Our Research

• Care Delivery

  • Ambulatory care
  • Behavioral health
  • Cardiovascular
  • Oncology
  • Pharmacy
  • Population health
  • Post-acute care
  • Service lines and specialty care
  • Weight management and obesity care
  • Women's health

  Learn more

  Strategy

  • Consumer trends
  • Finance
  • Health plan strategy
  • Healthcare policy updates
  • Hospital and health system trends
  • International
  • Market trends and growth strategy
  • Site-of-care shifts
  • State of the healthcare industry
  • Value-based care

  Staffing & Operations

  • Facility planning
  • Leadership
  • Nursing
  • Philanthropy
  • Physicians and medical groups
  • Provider operations
  • Sales enablement
  • Workforce

  Technology & Innovation

  • Artificial intelligence
  • Digital access and experience
  • Digital health
  • Medical device
  • Pharmaceutical
  • Telehealth

  LATEST RESEARCH

  

  Site-of-care shifts 2026: Inside the latest trends and data

  

  How data-driven risk reduction protects patients and providers

  

  4 steps for successful risk contracting with payers

  More latest research

  STAY IN THE KNOW

  Daily Briefing

  A must-read daily newsletter for thousands of healthcare executives across the nation.

  Radio Advisory

  A podcast providing your weekly download on how to untangle healthcare's most pressing challenges. New episodes drop every Tuesday.

• Tools

• FORECASTING & DEMAND

  • Market Scenario Planner
  • Demographic Profiler
  • Clinician Supply Profiler
  • Cancer Incidence Estimator

  COMPETITION & MARKET SHARE

  • Medicare Market Explorer
  • Health Care Facility Quickview Map
  • Health Plan Market Explorer

  PERFORMANCE IMPROVEMENT & BENCHMARKING

  • Care Variation Reduction Assessment
  • Hospital Benchmark Generator
  • Hospital Performance Profiler

  POST-ACUTE CARE & NETWORK DESIGN

  • Post-Acute Care Pathways Explorer
  • Home Health Performance Profiler
  • Home Health Benchmark Generator
  • Skilled Nursing Facility Benchmark Generator
  • Skilled Nursing Facility Performance Profiler

  See all tools

   

   

• Events & Webinars

• ADVISORY BOARD EVENTS

  In-person and virtual experiences to learn from the best in the healthcare industry and network with your peers.

  Upcoming Events:

  • March 31 ❘ Cardiovascular Roundtable: Tactics for sustainable procedure growth ❘ Virtual
  • May 05 ❘ Advisory Board 2026 Summit: Washington, D.C. ❘ In-Person
  • May 12 ❘ AI Roundtable: Unlocking AI’s role in care delivery and operations ❘ Virtual
  • June 02 ❘ Advisory Board 2026 Summit: Carlsbad, CA ❘ In-Person

  See all events

   

  WEBINARS

  Join your peers to learn the latest insights in our live and recorded webinars.

  Upcoming Webinars:

  • February 26 ❘ The top 10 trends impacting health systems in 2026: Part 1
  • March 03 ❘ The top trends in today’s infusion market
  • March 05 ❘ Medicare Advantage: Insights on today’s more competitive market
  • March 10 ❘ How Bellin Health’s VBC strategy saved employers $6.4M

  See all upcoming and on-demand webinars

• Products & Services
• 

  Research Membership

  Access to insights, resources, and tools designed to address the healthcare industry's most pressing challenges.

  • Research & Insights
  • Data & Analytical Planning Tools
  • Webinars
  • Expert Conversations
  

  ASKADVISORY

  Our direct-to-expert service is here to help you navigate your membership, our research, and your most pressing challenges in healthcare. No question is too big or too small.

  Custom Research

  Original research into the topics you care about most, conducted the Advisory Board way.

  Expert Support

  Connections to healthcare experts that help break through challenges and identify the most pressing opportunities.

  Advisory Board Fellowship

  An immersive leadership practice ground, empowering leaders to make progress on organizational challenges.

  Events & Roundtables

  In-person and virtual experiences designed to deliver crucial healthcare information and foster meaningful connections with peers and industry experts.

  Webinars

  Join our expert-led webinars to get the latest insights on topics such as the state of the industry, value-based care, health system strategy, specialty care market trends, and more.

  Sponsorship

  Thought leadership opportunities to elevate your brand, showcase your expertise, and engage with key decision-makers.

  See all Products & Services

• About Us

• ADVISORY BOARD

  We help leaders and future leaders in the healthcare industry work smarter and faster by providing provocative insights, actionable strategies, and practical tools to support execution.

  Learn more about us

   

   

  Who We Serve

  We empower our members, and the entire healthcare industry, to confidently reimagine healthcare with breakthrough insights that open minds and inspire action.

  OUR HISTORY

  Advisory Board has changed a lot over its 40-year history, but what has not changed is our commitment to addressing tough questions with unbiased, disciplined research.

  OUR EXPERTS

  Our team of 200+ curious researchers work full time to uncover the insights that you need to know and the solutions that will work.

  CAREERS

  Join us to improve the lives of others while doing your life's best work.

Questions? AskAdvisory

Library

| Daily Briefing

6 minute read ECMO can save lives. It can also become a 'bridge to nowhere.' Editor's note: This popular story from the Daily Briefing's archives was republished on July 30, 2023.

Wider use of extracorporeal membrane oxygenation (ECMO) machines has saved some patients from an otherwise certain death—but it can also leave people who have no chance of recovery in a medical limbo, Melissa Bailey reports for Kaiser Health News.

Read our primer to learn about growth drivers and program development considerations for ECMO

What is ECMO?

ECMO is an aggressive form of life support that pumps blood out of a patient's body, oxygenates it, and then returns it back to the body. The technology can keep a person alive for months, even if their heart and lungs aren't working, Bailey writes.

The machine originally was developed in the 1970s and has been primarily used for newborns. But use among adults began to climb after a clinical trial in 2009 showed positive results among adults with severe respiratory failure.

Ready-to-present slides: Cardiovascular market trends for 2021

In the United States, ECMO use tripled from 2008 to 2014 to almost 7,000 procedures, according to the Agency for Healthcare Research and Quality (AHRQ). Similarly, the number of hospitals offering ECMO has more than doubled since 2008, from 108 to 264, according to a registry run by the Extracorporeal Life Support Organization (ELSO).

Kenneth Prager, director of clinical ethics at Columbia University Irving Medical Center, said ECMO is creating "an entirely new paradigm. You have a heart that's not working, yet the patient is not dead."

But ECMO comes at a steep price, Bailey writes. According to the AHRQ, median charges for ECMO in 2014 were $550,000, which made it the 15th most-expensive procedure that year.

And many ECMO patients never experience any meaningful recovery. ELSO data show that just 29% of patients around the globe who receive ECPR (ECMO for cardiopulmonary resuscitation) survive, while 59% of patients receiving ECMO for their lungs survive, as do 42% of those receiving ECMO for their heart.

Bailey highlights four patient case studies that show ECMO's near-miraculous potential—and its often-disappointing reality.

The best-case scenario: A 'big shocker' recovery

Jessica Zitter was working in the ICU of a hospital in Oakland, California, when a 60-year-old patient came in after a heart attack, Bailey writes. According to Zitter, the patient's heart went into ventricular fibrillation, wiggling like "a bag of worms."

Hospital staff spent hours trying to revive the patient's heart before calling in an ECMO team from another hospital. By the time the team arrived, seven hours had passed since the patient first coded. Zitter said she wasn't optimistic the patient would survive—but to her amazement, he was able to recover and go home.

Zitter said the case was a "big shocker," but cautioned it was "a crazy, crazy, crazy outlier case with a crazy, crazy, crazy outlier response."

A harder outcome: The patient who never recovered

Not all cases are such a success. For example, Haider Warraich of Duke University Medical Center told Bailey about a patient who'd recently undergone a lung transplant and had collapsed from a heart attack. The man's heart was lacking oxygen and had sped into a malignant rhythm, Bailey writes, and he didn't respond to CPR or electric shocks.

Doctors elected to place the patient on ECMO, giving cardiologists time to perform surgery to unblock the patient's artery. Ultimately, though, the surgery was not successful. The man died after a month on the ECMO machine before he died.

Warraich said he felt using ECMO was appropriate in that case, but said doctors need more guidance on how to determine whether a patient would benefit from the machine. "If you have someone who is dying in front of you, it's really hard to step back and think about it," he said.

An agonizing scenario: The 'bridge to nowhere'

As Bailey reports, ECMO is "not designed to be a destination, but a bridge to somewhere," giving providers enough time to help a patient recover or receive a transplant or an implanted heart device.

However, when it's applied to patients who aren't ultimately able to receive any of these procedures, "ECMO can become a 'bridge to nowhere,' leaving the patient in limbo, possibly even awake and alert, but with no chance of survival outside the [ICU]," Bailey writes.

For example, a case report by Robert Truog, director of the Center for Bioethics at Harvard Medical School, in The Lancet described a 17-year-old boy who came to the ICU at Boston Children's Hospital in end-stage respiratory failure. The patient had already had one lung transplantation for cystic fibrosis and needed a new set of lungs, so the patient was placed on ECMO as a bridge therapy while he awaited his transplant, Bailey writes.

During this time, the patient was fully conscious, able to do homework, visit with friends and family, and text his friends. However, after two months in the ICU, the patient was diagnosed with untreatable cancer, making him ineligible to receive new lungs—and leaving doctors at a difficult crossroads.

3 ways to be thinking about VAD investment and program growth

Some doctors wanted to stop the ECMO treatment since the transplant was no longer possible, while others argued that the patient seemed to have a good quality of life inside the ICU, Truog wrote.

Ultimately, clinicians and the patient's family came up with an alternative: They elected not to replace the ECMO oxygenator, which needed to be changed every week or two once it developed blood clots. Without the replacement, the machine gradually failed over the course of a week, and the patient eventually lost consciousness and died, Truog said.

This "allowed him to die in a way where we didn't feel like we were choosing the moment of his death," Truog said.

A traumatic outcome: The patient who suffered PTSD

In other cases, doctors have found leaving patients on ECMO may cause trauma, as was the case with Philip Ayoub. After undergoing his third bypass surgery in December 2017, Ayoub experienced a series of mini-strokes, lost consciousness, and was transferred to Irving Medical Center, where he was placed on ECMO at his wife's request.

When he woke up, he asked his wife, Karen Ayoub, "Why am I here?" Ayoub's only treatment option was an implanted device to help his heart pump, but he grappled with whether or not to have the procedure—and eventually, so much time had passed that he became ineligible, Karen said.

In total, Philip spent two months in the ICU on ECMO. During that time, Karen said her husband began to experience post-traumatic stress disorder, along with night terrors and side effects from his medication. While Karen called the extra time together "a gift," if the situation were repeated, she said she's unsure whether her husband would have wanted to be on ECMO. "[H]e was the one laying in that bed for two months, being tortured by needles and night visions," she said.

Daniela Lamas, a critical care doctor at Brigham and Women's Hospital, said she sees both the potential and the limitations of ECMO.

"With every escalation and fancy machine comes a lot of hope," she said. "It's really hard to temper that hope with the realities that with each new thing comes a host of ethical questions and dilemmas."

ECMO, she said, is "a fantastic example of 'just because you can, doesn't mean you should'" (Bailey, Kaiser Health News, 6/18).

Your guide to ECMO program investment and development

Recent uptick in ECMO (extracorporeal membrane oxygenation) adoption nation-wide has increased provider interest in building ECMO programs. But ECMO may not be the right investment for every hospital due to its high start-up costs and complex, resource-intensive patient population.

Read our primer to learn about why ECMO utilization is growing and understand the investments in infrastructure; staff and care coordination; and program governance and referral strategy necessary to program success.

Download the Primer

Is this content helpful?

SPONSORED BY INTENDED AUDIENCE AFTER YOU READ THIS AUTHORS

Posted on June 24, 2019

Updated on July 26, 2023

TOPICS INDUSTRY SECTORS MORE FROM TODAY'S DAILY BRIEFING Daily Briefing

Q&A: What Amazon's big move into pharmacy means for you

Just-released court documents reveal how Amazon is planning to disrupt the U.S. pharmacy business—and shed light on how the tech giant wants to shake up the industry at large. Here's what you need to know about Amazon's latest moves, according to Advisory Board's Lindsay Conway. Daily Briefing

The 50 most influential clinical executives of 2019, according to Modern Healthcare

Former FDA commissioner Scott Gottlieb topped Modern Healthcare's annual list of the "50 Most Influential Clinical Executives" for the second year in a row. Daily Briefing

FDA approves new drug to treat low sexual desire in premenopausal women

FDA on Friday approved a drug to treat premenopausal women with low sexual desire—a condition known as hypoactive sexual desire disorder. Daily Briefing

Why are so many American teenagers dying by suicide?

The suicide rate among U.S. residents between the ages of 15 and 24 is at its highest since 1999, according to a new study.

We help leaders and future leaders in the healthcare industry work smarter and faster by providing provocative insights, actionable strategies, and practical tools to support execution.

Research & Events

• Latest research
• Daily Briefing
• Radio Advisory
• Events
• Search

Company

• About us
• Our history
• Products
• Sponsorship
• Careers

Support

• AskAdvisory
• Contact us

Social

• Facebook
• Instagram
• LinkedIn

• Legal Disclaimer
• Privacy Policy
• Terms of Use

Don't miss out on the latest Advisory Board insights

Create your free account to access 1 resource, including the latest research and webinars.

Create Account Sign in to your account

Want access without creating an account?

   

Get Limited Access

You have 1 free members-only resource remaining this month.

View this resource

1 free members-only resources remaining

Become a Member

1 free members-only resources remaining

Create Account

You've reached your limit of free insights

Become a member to access all of Advisory Board's resources, events, and experts

Never miss out on the latest innovative health care content tailored to you.

Become a Member

Benefits include:

Unlimited access to research and resources Member-only access to events and trainings Expert-led consultation and facilitation The latest content delivered to your inbox Become a Member

You've reached your limit of free insights

Become a member to access all of Advisory Board's resources, events, and experts

Never miss out on the latest innovative health care content tailored to you.

Create Account Become a Member

Benefits include:

Unlimited access to research and resources Member-only access to events and trainings Expert-led consultation and facilitation The latest content delivered to your inbox

This content is available through your Curated Research partnership with Advisory Board. Click on ‘view this resource’ to read the full piece

View this resource

Email ask@advisory.com to learn more

Click on ‘Become a Member’ to learn about the benefits of a Full-Access partnership with Advisory Board

Never miss out on the latest innovative health care content tailored to you. 

Become a Member

Benefits Include:

Unlimited access to research and resources Member-only access to events and trainings Expert-led consultation and facilitation The latest content delivered to your inbox Become a Member

This is for members only. Learn more.

Click on ‘Become a Member’ to learn about the benefits of a Full-Access partnership with Advisory Board

Never miss out on the latest innovative health care content tailored to you. 

Become a Member

Benefits Include:

Unlimited access to research and resources Member-only access to events and trainings Expert-led consultation and facilitation The latest content delivered to your inbox Become a Member You Session Is Expiring

Your session is about to expire. Click continue to stay logged in.

Auto logout in seconds.

Continue Logout Thank you! Your updates have been made successfully. Oh no! There was a problem with your request. Error in form submission. Please try again.