Thread by @nytimes

Throughout the pandemic, wrenching scenes have played out across the U.S. as doctors found themselves rationing a treatment in short supply — not ventilators, as initially feared, but a therapy called ECMO. nyti.ms/3hz9rpi

ECMO is an intensive treatment that is considered a last resort for those severely ill with Covid-19. Placing a high demand on both a hospital’s equipment and manpower, it at times could not be given to everyone who might benefit. nyti.ms/3xGdXrK

Health officials in the U.S. were initially concerned that ventilators would be in short supply, but concerted efforts helped avoid that. ECMO, on the other hand, is offered in less than 10% of hospitals. It’s also sometimes needed for cardiac surgery. nyti.ms/3xGdXrK

Short for extracorporeal membrane oxygenation, ECMO adds oxygen and removes carbon dioxide from the blood before pumping it back to the patient, allowing the lungs or heart to rest. ECMO patients require constant monitoring and one-on-one nursing. nyti.ms/3xGdXrK

While a course of ECMO often lasts four or five days for respiratory failure, Covid patients can require weeks. Since early in the pandemic, doctors have faced difficult choices about who should receive it — and for how long. nyti.ms/3xGdXrK

“There are just so many inequities,” said Dr. Terese Hammond, an ICU director in Southern California. And for every Covid patient who survived with ECMO, there are “probably three, four, five people that die on the waiting list.”

In the absence of regional sharing systems to ensure fairness and match resources to needs, hospitals and clinicians were left to apply differing criteria, with insurance coverage, geography and even personal appeals having an influence.

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