[HN Gopher] Covid patients pushed medical extremes in life suppo...
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Covid patients pushed medical extremes in life support breakthrough
Author : tomhoward
Score : 88 points
Date : 2022-04-28 15:03 UTC (1 days ago)
(HTM) web link (www.heraldsun.com.au)
(TXT) w3m dump (www.heraldsun.com.au)
| spacexsucks wrote:
| Side note: I get this
|
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| You know I dont want your content herald.
| jeroenhd wrote:
| Wow, that's pretty terrible. You can use archive links
| (https://archive.ph/idtyC) if you care enough but the way this
| website treats visitors made me lose interest in the story all
| together.
|
| If I click the link om redirected to some subdomein that's
| blocked by my PiHole so that's also quite telling.
| abathur wrote:
| As a counterpoint (anecdata...) to some comments here...
|
| After contracting covid around Christmas and ~recovering over
| about 2 weeks, one of my younger sisters, 31 + pregnant, started
| feeling short of breath in late February. She went into the
| hospital, was held for observation/testing for a little over a
| day but was in good spirits.
|
| Healthy. No major preexisting conditions before covid (aside from
| pregnancy and some allergies). No ~ground-glass anomaly (as I
| understand it).
|
| She went into acute respiratory distress in the wee hours of the
| morning. Intubation helped get oxygen in, but C02 was building in
| her blood. Within 4 hours, they made the call to put her on ECMO.
| They needed to wheel her to another wing of the hospital and told
| her husband she might not even last that long. The chaplain
| followed them over.
|
| Once there, they sprayed the walls and bed with her blood, and
| made her a cyborg for a week. And then we got her back.
|
| (Well. Kinda. She was diagnosed with pre-eclampsia during this
| episode, and is having to live in the hospital until she
| delivers.)
|
| She is, demographically, the kind of patient that merits
| interventions like this. As the news filtered to me several
| hundred miles away in spurts and haunting silences, I started my
| grieving when I heard she'd been intubated. ECMO was the only
| light in the tunnel.
|
| (* I write this as a selfish brother with zero knowledge of the
| long term financial consequences to my sister and her young
| family.)
| fujidust wrote:
| Best of luck to her and family. My heart goes out to you all.
| chinathrow wrote:
| Wow, that was hard to read. Was she vaccinated against Covid?
| abathur wrote:
| She had an initial 2-shot course, but shied away from the
| booster after she found out she was pregnant (in late Oct,
| iirc.)
| psychlops wrote:
| Out of curiosity, of what will the answer inform you?
| barrkel wrote:
| If she was vaccinated, then COVID sounds like it could
| still be a big problem.
|
| If not, then the current general impression of COVID
| largely being behind us (us being the vaccinated world) is
| still tenable.
| nradov wrote:
| Causality is never clear in individual cases. With
| millions of cases worldwide there will always be
| occasional outliers due to genetics or environmental
| factors or random luck. Severe COVID-19 symptoms have
| always been rare in that age group, and multiple large
| scale clinical trials have shown pretty conclusively that
| vaccination cuts the risk still further. But vaccines are
| never 100% effective, and individual anecdotes don't tell
| us anything useful about vaccine efficacy.
|
| SARS-CoV-2 can never be eradicated and it will continue
| killing people just like other endemic respiratory
| viruses such as influenza, RSV, HCoV-OC43, etc. At this
| point the majority of Americans have already been
| infected so it's time to accept the risk and move on,
| regardless of how well the vaccines work.
|
| https://www.npr.org/2022/04/26/1094817774/covid-19-infect
| ion...
| bonzini wrote:
| Respiratory distress is a symptom of preeclampsia.
| Doesn't have to be related to COVID.
| abathur wrote:
| As I understand it, she wasn't diagnosed with
| preeclampsia (despite being a pregnant woman in a
| maternity hospital for shortness of breath--for ~36h)
| until after she was placed on ECMO. Her levels (I think
| maybe liver enzyme is what matters?) fell back into
| normal range within a few days of coming off ECMO, but
| they do not reverse the diagnosis once given.
| beamatronic wrote:
| "Vaccinated" is not really a Boolean. It is a list of N
| vaccine types and administration dates. After all, the
| protection fades over time, subject to many variables.
| khazhoux wrote:
| Relevance? The question still has a boolean answer
| (modulo booster), regardless of the menu of vaccine
| options.
| kxyvr wrote:
| I'm really sorry that happened to your sister, but I'm also
| glad that's working out. Really, despite all of the pessimism
| about end-of-life decisions, ECMO is good technology and your
| sister's case is good evidence of that. I think what gets mixed
| up in all of this conversation is that what may be a good idea
| when you're less than 60 may not be a good idea when you're
| over 90.
|
| As a side note, evidently, the French have really good medical
| technology and practice. They have been able to run ECMO in a
| Paris subway in order to save someone's life:
|
| https://www.jems.com/patient-care/how-physicians-perform-pre...
|
| I really do hope this kind of measure can be made more readily
| available. Till then, I'm still happy it works for people like
| your sister.
| neonate wrote:
| https://archive.ph/idtyC
| chiefalchemist wrote:
| Ok. But at what cost? Not financial cost per se, but along the
| lines of opportunity cost. These efforts, while very impressive,
| consume a significant (read: disproportionate) amount of
| resources. Resources that could possibly be deployed elsewhere.
|
| I'm not suggesting it was foolish to do this. But there is
| broader context for "do no harm".
| sonicggg wrote:
| If you are bad enough to need ECMO, you may as well wish you were
| dead. Not sure what is better.
|
| Little is talked about the life of these people after they are
| "saved", whatever that word means. Besides sequelae from Covid
| itself, you're getting ECMO sequelae as a cherry on top. You
| can't just go back to life as it was.
| queuebert wrote:
| My wife treats ECMO patients, and it is not uncommon for them
| to attempt suicide by pulling out the cannulas. A couple have
| succeeded. What follows is a rapid exsanguination over the next
| few minutes as the machine pumps their blood onto the floor at
| 2 L/min. That tells me the quality of life while on treatment
| is not good.
|
| The ones that survive the treatment (less than half) are never
| the same. But they aren't dead.
| ceejayoz wrote:
| I'd be cautious assuming intensive care patients are entirely
| of right mind. Something in ICU treatment tends to induce
| delirium/psychosis.
|
| https://www.hopkinsmedicine.org/news/publications/hopkins_me.
| ..
|
| > The sickest of survivors frequently experience delirium at
| some point in their course of treatment. The condition occurs
| in 70 to 80 percent of acute respiratory failure cases,
| according to a 2013 study in the New England Journal of
| Medicine. Among the elderly the ICU delirium rate is
| similarly at about 80 percent, experts say.
| rob74 wrote:
| Not just ECMO, people who were "only" on a respirator for a few
| weeks/months also have their fair share of issues afterwards.
| Makes you think reading stories like these should be enough to
| convince anyone to get vaccinated. But some people are still
| convinced that this won't happen to them if they get Covid,
| however they fear any number of side effects from the
| vaccination...
| bsder wrote:
| > But some people are still convinced that this won't happen
| to them if they get Covid, however they fear any number of
| side effects from the vaccination...
|
| Ayup. Had a close relative like this--he was about 10 years
| younger than me and still has a teenager. He got Delta and
| wound up on ECMO. He didn't make it.
|
| All because anti-vax was part of his social identity.
|
| And it's not like he didn't know. _I_ got Covid Original
| Flavour(tm) and loudly told everybody around me how much it
| sucked (it was basically the 3rd sickest I 've _ever_ been in
| my life) and all the side effects I got from it.
| azinman2 wrote:
| Just go read the sister thread right now on myocarditis in
| Israel... people are calling for tribunals on medical
| malpractice for forcing people to get vaccines...
| DontMindit wrote:
| Can you link the thread please. I looked through your
| profiles other comments but I didn't see it.
| nradov wrote:
| I don't know if there is a discussion thread but an
| Israeli study was just published yesterday which found an
| association between COVID-19 vaccination and myocarditis
| in young men.
|
| https://doi.org/10.1038/s41598-022-10928-z
|
| (I am not taking a position on the findings of that
| study, just providing a link as a reference.)
| somenameforme wrote:
| Not the person you're responding to, but if you're
| unaware/interested in relevant data this study [1] was
| just published 10 days ago and it's interesting. It
| compared the rates of myocarditis/pericarditis only
| within the 28 day period following vaccination to the
| rates experienced by unvaccinated individuals over a
| sample of 23 million Europeans.
|
| Keep in mind the metric they use (IRR - incident rate
| ratio) is a ratio, not a percent. So an IRR of 15 means
| 1500% more events. Table 2 lays out everything quite
| nicely. To see it you need to click on figures/tables and
| scroll down a bit.
|
| [1] - https://jamanetwork.com/journals/jamacardiology/ful
| larticle/...
| robocat wrote:
| Probably this:
| https://news.ycombinator.com/item?id=31202038
|
| I suggest you use https://hn.algolia.com/ to search for
| past stories or comments (make sure to use the correct
| combo selections, otherwise it won't give you what you
| want!).
| jessriedel wrote:
| Every time I read about ECMO, the stories are saturated with
| weird comments by doctors and hospital officials about its
| "proper use", whether they are doing the right thing to use it,
| etc. Explicitly they say the concern is for the patient (whether
| the potential suffering is worth it given the high chance of
| death), but I can't square this with the numbers and with other
| medical practices. Unless there is some extreme physical torture
| associated with EMCO that's not mentioned, being on EMCO for a
| week or month or 6 months seems obviously worth it for a 50%
| chance of survival from the patient's perspective. Other patients
| with different illnesses routinely spend giant amounts of time in
| the ICU with much slimmer odds. Nothing I read in these articles
| suggests to me that ECMO stands out unusually above the high
| background levels of suffering in a modern hospital.
|
| I suspect the underlying cause of the handwringing is the immense
| cost of ECMO (hundreds of thousands of dollars) and the distinct
| possibility that a patient ends up dependent on it (marginal cost
| >$5k per day) with no obvious ethical threshold for withdrawing
| care, at least according to the official prevailing norm that
| mere cost cannot be a reason to do so. This article is
| substantially more direct about that:
|
| https://khn.org/news/miracle-machine-makes-heroic-rescues-an...
|
| Very interested to hear commentary from people who know more
| though.
| meroes wrote:
| What do the survivors deal with though? I recently had an
| injury that required surgery and occupational therapy. My
| entire limb was a sad, useless appendage for months mostly due
| to immobility and how it reacted to pain. I can't imagine the
| mountain one must surmount to get back to even 25% of their pre
| illness self. I was down to 15% use by the time my OT started.
| And 6 months later it still is a daily task to keep improving
| (much better now though).
|
| It must take an incredible toll and on already sick body.
| ceejayoz wrote:
| Cost isn't the only consideration; staffing is also important.
| ECMO is extremely high-touch (1:1 nursing recommended, and some
| patients may need 2:1), even compared to other ICU procedures;
| given a primary concern during the pandemic was running out of
| ICU capacity, a bunch of patients on ECMO can cause you to get
| to that point much more rapidly.
| JshWright wrote:
| Staffing is a component of the cost.
| ceejayoz wrote:
| Staffing and cost are related, but there are staffing
| requirements that no amount of money thrown at them can
| fix.
| munificent wrote:
| Nurses are not an infinitely fungible commodity.
| JshWright wrote:
| No, but a significant cause of current staffing shortages
| are stagnant wages (especially for non-travel nursing
| roles).
|
| Hospitals paying decent wages to full-time/permanent
| staff would go a long way towards solving staffing
| shortages.
| mrkstu wrote:
| It's also an absolute availability issue. A hospital has,
| in the near to intermediate time horizon, the staff that it
| has. So dedicating staff in such ratios make them
| unavailable to other patients, so triage considerations
| come into play.
| carbocation wrote:
| ECMO is high risk for the patient, especially venoarterial (VA)
| ECMO which is probably _not_ what is being described in this
| article. Venovenous (VV) ECMO doesn 't dump blood into the
| arterial tree, so your risk of stroke or other arterial
| thrombotic complications is much lower. You still risk
| infection and venous clotting (and therefore the risks of
| iatrogenic anticoagulation), but I think most of us would
| accept those risks.
|
| From a systems standpoint, the use of mechanical support
| usually makes sense in the context of being a bridge to
| somewhere that is not in-hospital, _even in the event of non-
| recovery_. At least where I practice, we want to be able to
| offer a durable device, or transplantation, if you don 't
| recover. If you live in a place where the health system would
| not offer transplantation (e.g., because of some risk factor
| like advanced age), then offering ECMO makes less sense because
| it is not a bridge to anywhere, particularly for VA ECMO.
|
| For VV ECMO, I think there has long been a recognition that
| people can do OK for an extended period of time (in contrast to
| VA ECMO, where the risks are higher and there are also
| destination therapies like ventricular assist devices). And if
| you're waiting for a lung transplant vs recovery, you may be
| waiting for quite awhile. To this end, there are special
| catheters for VV ECMO that facilitate mobility so you can
| retain some degree of strength and mobility while on ECMO
| (e.g., https://www.getinge.com/int/product-catalog/avalon-
| elite-bi-... ).
|
| I'm closer to VA ECMO than to VV ECMO (but do neither); still,
| your comments ring more true for me about VV ECMO (which again
| I think is the subject of this article), whereas I think that
| patient risk + superior bridging/destination strategies really
| do dominate the VA ECMO discussion.
| dr_coffee wrote:
| One important distinction is to understand that VA ECMO is
| more often used as mechanical circulatory support in cases of
| severe heart failure leading to cardiogenic shock. Used alone
| or in conjunction with other mechanical devices (balloon
| pumps or impella pumps) it can augment cardiac output to
| provide sufficient perfusion and oxygenation of your organs
| and distal extremities.
|
| VV ECMO, on the other hand, is used purely for gas exchange
| (O2 and CO2) due to respiratory failure. Much of the debate
| in the critical care community is centered around which
| circumstances and patients derive the most benefit from
| initiation of VV ECMO. The best studied use case, is in the
| setting of acute respiratory distress syndrome, which is
| defined by very specific criteria (bilateral noncardiogenic
| pulmonary edema with ratio of arterial oxygenation partial
| pressure to fraction of inspired oxygen less than 300 mmHg).
| The EOLIA trial published in NEJM in 2018 looked at early
| initiation of VV ECMO in patients with severe ARDS [1]. It
| demonstrated no mortality benefit of ECMO, however many say
| that the study was not appropriately powered as the
| assumptions used to design the study were from 2008 when
| mortality from ARDS was much higher. Re-analysis of the data
| from the EOLIA trial using bayesian methods suggests that
| there might actually some benefit to early initiation of ECMO
| [2]
|
| 1. https://www.wikijournalclub.org/wiki/EOLIA
|
| 2. https://jamanetwork.com/journals/jama/fullarticle/2709620
| jessriedel wrote:
| Thank you for this reply. Highly informative.
|
| > whereas I think that patient risk + superior
| bridging/destination strategies really do dominate the VA
| ECMO discussion.
|
| Is the idea here that when doctors are considering VA ECMO
| for a patient there is usually some non-trivial chance that
| the patient survives without it? In that case the choice, I
| guess, is between higher survival with more complications (VV
| ECMO) and lower survival with fewer complications (no ECMO)?
| carbocation wrote:
| Sort of a facile response but we'll at least _consider_ VA
| ECMO if we think the benefits outweigh the risks. E.g., a
| person in worsening cardiogenic shock because of a usually
| reversible insult (e.g., severe stress cardiomyopathy, or a
| refractory ventricular arrhythmia) has a very good chance
| of surviving the acute hospitalization but if I 'm worried
| they will die tonight (even if they'd be fine 2 days from
| now after some recovery time) then will discuss VA ECMO
| with the people who actually do it for a living. VA ECMO's
| complications are a consideration in that calculus. That's
| the kind of decision where I think an observer could argue
| (especially if things go well) that there was a non-trivial
| chance that the patient would have survived without ECMO.
| ausbah wrote:
| not trying to play doctor here, but a quick skim through the
| wikipedia article shows a high risk for developing neurological
| issues, infection, and blood related ailments
|
| I imagine, and I hope someone with more knowledge can add on or
| correct me, that medicinal professionals are generally
| reluctant to use ECMO for extended periods due to the
| aforementioned issues. I personally know if my odds of waking
| up brain dead from a procedure were 50-50%, I wouldn't take
| that risk. so I wonder if doctors in this case saw a
| corresponding decrease in such risks?
|
| https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygen...
| jessriedel wrote:
| > I personally know if my odds of waking up brain dead from a
| procedure were 50-50%, I wouldn't take that risk.
|
| You would accept guaranteed death to avoid a 50% chance of
| brain death? That's not necessarily an inconsistent
| preference, but it's a highly unusual one.
| ceejayoz wrote:
| The poster's point would've made more sense, I think, if
| they'd used "significant cognitive impairment" instead of
| brain death.
|
| Being left in a permanent state where I'd be conscious
| enough to _want_ to die, but not be able to legally access
| that option, is a scary thought. I 'd rather not live in a
| nursing home bed for fifty years.
| vkou wrote:
| Fortunately for your case, once people are bedridden,
| they very rarely survive fifty years.
|
| Our bodies don't work very well when they can't keep
| moving.
| coderaptor wrote:
| Did you consider the impact on those responsible for your
| long term care?
| krisoft wrote:
| Brain dead is dead. [1] There is no long term care. They
| turn off the machines pumping air in your chest and
| that's it.
|
| I think you are confusing brain death with vegetative
| state caused by severe brain damage.
|
| 1: https://www.nhs.uk/conditions/brain-death/
| leereeves wrote:
| I'm not a doctor either, but doesn't chemo have similarly
| high risks of serious side effects? When the odds of death
| are close to 100% otherwise, a treatment that improves those
| odds to 50% doesn't sound so bad.
| JohnBooty wrote:
| My understanding is that hesitation to employ ECMO isn't
| about the risk of failure.
|
| It's not like chemo or dialysis where you can live some
| kind of meaningful life while the treatment has an X%
| chance of buying you Y years.
|
| It's extremely labor intensive. Another commenter mentioned
| 1:1 fulltime nurse care. If true, that means multiple
| fulltime employees, working in shifts, per ECMO patient.
| Given finite medical resources (doctors, nurses, beds, ECMO
| machines) we would like to make sure we're employing this
| only for patients who have a hope of recovering afterward.
|
| In that sense it is similar to other "extreme measures"
| like ventilators and so on. We can sometimes keep somebody
| alive in a totally nonviable state for an extended amount
| of time after heart and/or lung failure, but if there's
| zero chance for recovery it just doesn't make sense from an
| ethical or practical standpoint.
|
| (edit - when I say "we" I mean society. not "we" as in "we
| medical professionals." I am not a medical professional!)
| jessriedel wrote:
| > We can sometimes keep somebody alive in a totally
| nonviable state for an extended amount of time after
| heart and/or lung failure, but if there's zero chance for
| recovery it just doesn't make sense from an ethical or
| practical standpoint.
|
| There are people on ECMO who have permanent heat and/or
| lung failure but are conscious, comfortable, and do not
| wish to have care withdrawn. In this case, it can
| absolutely make sense to continue to support them even if
| they have no hope of getting off the machine. The non-
| trivial ethical question is what to do if the cost is
| extremely high.
|
| > Given finite medical resources (doctors, nurses, beds,
| ECMO machines) we would like to make sure we're employing
| this only for patients who have a hope of recovering
| afterward.
|
| Outside the short-term, we can always hire more nurses
| and docs, and build more machines and hospital rooms. We
| should not pretend that the amount of these are fixed in
| order to justify withdrawing expensive but beneficial
| care (other than in emergency situations). If we are
| going to withdraw care because we just don't want to pay
| for it given the size of the benefits, we should
| acknowledge this explicitly.
| JohnBooty wrote:
| I'd love to know more about this infinite pipeline of
| doctors and nurses you're referring to! Most coverage
| I've read lately has been about healthcare workers
| quitting in droves, so it's a relief to know that there
| are actually no limitations here. If we
| are going to withdraw care because we just don't
| want to pay for it given the size of the
| benefits, we should acknowledge this explicitly.
|
| I feel like the discussion is super explicit about this?
|
| For nearly all situations, I would agree that nobody
| should be suffering or dying because of a lack of
| willingness or ability to provide or pay for medical
| services.
|
| But there are practical limits. There is a reason why we
| don't all get weekly mammograms, prostate exams, and
| dental checkups even though this would inarguably be the
| most effective way to catch things early.
| kingkawn wrote:
| This is a serious decision, not just between 100% death and
| 50%, but a significantly worse death for the other half of
| people than the original certain one.
|
| Take the final period of a person's life from them and
| their family for a devastating treatment that doesn't help
| and then see how simple of a choice it feels.
| pnutjam wrote:
| death and serious brain damage are not the same risk
| kingkawn wrote:
| The negative side effects are not to be taken lightly,
| especially if they cause profound suffering prior to a
| patient's death or severe lifelong morbidity for a survivor.
| Yes, there are amazing uses of the technology, but the doctors
| who refer to proper use are speaking from a place of having
| seen the improper use.
| cat_plus_plus wrote:
| I think the right thing to do for the time being is to consider
| prolonged use of ECMO as a research practice where not everyone
| is accepted but those accepted taken care off as long as they
| are conscious or have a decent chance of regaining
| consciousness and making their own informed decision. Costs of
| doing so are part of research budget that determines how many
| patients can be included. Not providing care to everyone is
| ethical so long as we don't know if the care is going to help
| anyway.
|
| In turn, research can determine - Exactly what kind of patients
| are most likely to recover after prolonged use of current ECMO
| machines - Potential ways to bring equipment and nursing costs
| down while preserving most of effectiveness. - Ways to wean the
| patient off intensive care long term.
|
| For example, the very first genetically modified pig heart
| transplant resulted in 2 months conscious survival. Even if
| animal transplants never become a long term solution, they
| could prove more cost and medically effective than ECMOs to buy
| time for own organ recovery or a human transplant.
| Fomite wrote:
| A lot of my infection control colleagues are rightly terrified
| of keeping people on ECMO or mechanical ventilation due to
| infection risk, that are _extremely_ hard to treat.
|
| This was especially acute during the early phase of the
| pandemic, when the combination of the intensity of care COVID
| patients required + the PPE shortage meant some compromises
| that they'd really prefer not to make.
| kxyvr wrote:
| Outside of the other comments here, I would also suggest
| considering the expected outcomes rather than just whether or
| not someone will live and die. For example, if someone spends a
| month on ECMO and the end result is that they're neurologically
| devastated, require a feeding tube, tracheostomy, and get
| discharged to an LTAC, was it worth it? If someone can never
| have a conversation again, or hold they're children, or read a
| book, was it worth it? If someone is likely to die, is it worth
| it to break their ribs or cover them in their own blood and
| fluid when they code? Given how sick someone is when they're
| put on ECMO, these are all realistic and likely outcomes.
|
| And, look, this is a value choice that families have to make,
| but also one that most have not considered before getting sick
| and don't really want to consider when they're thrown into that
| situation. Physicians know about these likely outcomes, so it
| affects their opinion about its use.
|
| As a brief aside, if anyone does end up in this situation, it's
| stressful and I'm sorry that you're going through this. Really.
| If I could offer one unsolicited suggestion, it would be to
| discuss the possible and likely outcomes with your physician,
| beyond life and death, so that you can make an informed
| decision that's best for your family.
| vkou wrote:
| Not to mention the costs.
|
| Medical resources are limited, and in a country where we are
| chronically under treating people, it makes no sense to
| torture someone with an ECMO for a month, only for them to
| 'recover' to the state mentioned above.
|
| That money/medical effort could have been used to
| save/significantly improve the lives of dozens of people,
| instead of prolonging the death of one.
|
| It all comes out of an insurance pool, it's not like people
| are bearing ECMO costs out-of-pocket. It all comes out of the
| same labour pool, when you've got your entire medical staff
| put on hopeless cases, there are people who could be helped
| who are being denied treatment.
| nradov wrote:
| We are both chronically under treating some patients and
| over treating others. Over treatment is a leading cause of
| iatrogenic harm. Some providers default to aggressive
| treatment whether due to a sincere belief that it's best
| for the patient, or to satisfy patient requests, or to make
| more money. But evidence based medicine guidelines indicate
| that it's often best to do nothing beyond active monitoring
| of the patient's condition.
|
| https://dx.doi.org/10.1371%2Fjournal.pone.0181970
|
| Ideally we should be allocating limited medical resources
| based on formulas that maximize overall benefit as
| quantified by quality-adjusted life years (QALY). But it's
| politically difficult to set rational policies around
| rationing care without triggering toxic disputes about
| "death panels" and "killing grandma".
| kurthr wrote:
| To give some color. I haven't heard that marginal costs are
| ~$5000/day, I have heard they are closer to $20k/day. Granted
| other procedures were involved, but one ECMO stay was over
| $12M for 4 months. That is closer to $100k/day.
|
| How many other people could you save (even within the same
| healthcare system) for that kind of money? These long tails
| have huge impacts on insurance costs.
| throwaway6734 wrote:
| Yep that's insane. That's the same as giving 1,000 families
| $1000 a month for the first year that their child is born.
| Surely that would have a significantly larger positive
| impact on society
| conductr wrote:
| No supporting data other than my decades working in
| healthcare and having conversations with coworkers versus my
| non healthcare working family/friends.
|
| I'd say those in the medical community that have been more
| exposed to what that altered reality looks like, tend to not
| want it for themselves. That is to say, they'd rather expire.
| They'd probably also use that info to inform choices they
| made for loved ones in a similar situation.
|
| The general population is very mixed but there seem to be
| more folks on relative basis that would keep someone alive at
| all costs or try anything to save them regardless of the
| risk. I also think sometimes it just comes down to medical
| professionals being able to come to grips with the reality of
| the situation and make a hard decision when others default
| choice is keep them alive /try anything.
|
| Aside: I worked in a hospital from 18-25 and have basically
| seen it all as my job had me in every department caring for
| every patient and I notice when something crazy happens I
| still have the ability to not be consumed with shock but
| assist. I recently saw a pedestrian/auto accident and was on
| foot myself. About 30 folks around saw it happen. Everyone
| froze or turned away in disgust. I ran and basically took
| control of the situation until EMTs arrived. This has
| happened a few times in my life and I can't help but to
| correlate it to my exposure to the hospital environment.
| andi999 wrote:
| Some countries do not perform hemicorporectomy, since they
| think survival would not be worth it.
| patchtopic wrote:
| old Melbourne saying: "Is it the truth, or did you read it in the
| Herald Sun?"..
|
| like any Murdoch rag it sometimes might put out a news article to
| keep up appearances, but there is usually a better source..
| unwind wrote:
| Completely unreadable for me due to three hovering ads, along
| three edges of the screen. Easily the worst experience I can
| remember seeing.
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