by Keren Setton
Hagi Dekel, a cardio-thoracic surgeon at the Wolfson Medical Center in central Israel, uses his extensive experience as volunteer to help COVID-19 patients.
As head of the cardio-thoracic department and manager of the ECMO unit, Dekel usually operates on children, often young babies, and adults in need of open heart surgery.
For years, Dekel has volunteered at Save a Child’s Heart (SACH), an Israeli-based international non-profit organization aimed at improving pediatric cardiac care for children in developing countries.
The team of volunteers, doctors, nurses, technicians and other support staff, has gained valuable experience in cardiac care which includes frequent use of the ECMO machine. ECMO, the shortcut for extracorporeal membrane oxygenation, is basically a lung and heart bypass machine.
After operating on thousands of children from over 60 countries, the expertise that the SACH volunteers have accumulated especially in the use of the ECMO machine is coming in handy when treating patients with COVID-19 when doctors have exhausted all other treatment possibilities.
It is being used around the world to help critically ill patients at varying success rates. While there is no clear-cut data on the benefit of ECMO in COVID-19 patients, the World Health Organization (WHO) recommends offering the treatment to eligible patients.
In Israel, over 16,000 Israelis have been diagnosed with the virus since the outbreak in the country in March. Most of them have already recovered. Over 230 people have died. In the beginning of this week, just over 70 patients are in need in ventilation.
COVID-19 patients who are critically ill often exhaust the traditional ventilation. The damage to the lungs is extensive and this is where ECMO comes in.
“It is not a cure or a medication, it gives the care-givers time,” Dekel told Xinhua, “It gives the patient time to recuperate.”
Dekel describes it like a cast. While a broken arm can be put to rest while in a cast, the lungs and heart cannot be stopped in order for a patient to recover.
But it is not without complications, ranging from increased risk of infection, to blood clots and strokes or bleeding from pre-emptive blood thinners. Therefore, especially in COVID-19 patients, there is careful consideration before hooking someone on the machine.
“It is another option, but when we really have no other choice,” he added.
The accumulated experience of 25 years and many staffers has made SACH volunteers some of the most fit in Israel to help treat critically ill COVID-19 patients. Dekel established the ECMO unit at Wolfson Medical Center several years ago. Little did he know that his experience would come in handy during a global pandemic.
“For my whole career and life with SACH, the experience the team and I have is extensive and gives us an advantage in treated COVID-19 patients,” he said.
His team has been called to other hospitals in the country to help in cases where the machine has been put to use.
In a rare case in Israel, Dekel and his team treated Shimon Sasson, a previously healthy 45-year-old man, who suffered several complications due to the COVID-19. Sasson was hooked to the ECMO machine for 29 days until he was weaned from it. Sasson was released from hospital in late April.
“He went home as if nothing happened to him,” said Dekel.
In anticipation for a massive influx of patients, Israel raced against time to prepare for COVID-19. In addition to prepping hospital wards and increasing staff, the Israeli health ministry ordered 30 additional ECMO machines, to add to the 40 existing in the country.
The use of the machine is not only complex but involves use of major resources, including intensive monitoring by staff members. With protective gear, this care is even more complex and poses major challenges to staff.
“You cannot take care of them from afar like it is done with many virus patients,” said Dekel.
Hooking up a patient to ECMO carries a significant risk. According to Dekel, there is a strict criterion when deciding to enlist the machines help. Patients are usually young and experiencing only single organ failure.
Most of the critically ill patients in Israel have been above the age of 60, according to health ministry data. The elderly is also a significant portion of the mortality rate in the country.
“Because of most of the sick in Israel are older, there was not a massive use as we expected,” he told Xinhua.
Although Israel is currently experiencing a significant reduction in new cases, there is anticipation for a second wave of the virus in the coming winter which may put the excess ECMO machines into use once again.
According to Dekel, between 50-60 percent of the patients who needed ECMO in Israel as a result of the virus, were successfully weaned off from the machine. Enditem