Sustainability in healthcare goes beyond environmental costs to include social, economic, and clinical outcomes [1]. By adopting sustainable practices, we can enhance healthcare quality and build systems that support both individual health and community resilience. Application of the ECMO system as a therapy has come a long way since its conception is the late 1960s, but there is room for improvement in terms of its long-term viability and patient accessibility.
Reduction of complications and achieving high survival rate: ECMO usage is commonly associated with blood clotting (thrombosis), hemorrhaging and bacterial infection. These can be minimised through the implementation of new technology and materials, like using AI for early thromobsis detection and localisation, and the addition of biomaterial coatings that can combat or prevent bacterial infections in the bloodstream, as seen previously.
This involves improving the durability of the ECMO and its constituent parts that are frequently discarded in landfills, like the cannulas and tubing [3]. Metal cannulas are commonly made from stainless steel [6], but replacing this with heavy metals like titanium alloys and incorporating ceramics such as those used in dental equipment [7] where possible will both increase biocompatibility as well as durability of the cannula, making it more long lasting. This will also ensure that the cannulas can be used more than once after sterilisation.
The use of biodegradable zwitterionic polymeric hydrogels as oxygenation membranes would prove sustainable in the long-run while contributing to anti-thrombotic activities [5]. Replacing plastics like polyurethane found in the main casing of the ECMO device, with biodegradable lactide-based plastics and polyanhydrides [8] will also ensure safer disposal of the machine once it reaches the end of its life.
Minimise cost: by incorporating the new technologies discussed previously and taking into account the durability of the machine and its parts, a more efficient and long-lasting ECMO would decrease maintenance and operation costs in the long-run, a benefit which can be passed down to the patient in terms of higher quality and cheaper treatment.
Shorten duration of hospital stay: measures to reduce infection and thrombosis/hemorrhage rates can speed up the recovery process with fewer complications to be treated. Additionally, the wearable trackers can extend patient survival outcomes at minimum cost due to early thrombosis detection and non-invasive nature.
Make more accessible: currently ECMO is only available in specialised hospitals in large cities. We can bring ECMO to many more people by mobilising the system. This involves a combination of reducing the size of the machine and the space it takes up, as well as making it easier to transport. An "ECMO on wheels" initiative could provide ECMO services to hospitals in smaller cities and towns, or general hospitals, similar to an ambulance service. To do this, the monitors can be mounted on the wall of the vehicle, removing the need for large stands or wheels which take up a lot of space. Elliot Aviation, is currently developing a transport system for the ECMO, that is lightweight and takes less space, while efficiently packing the ECMO [4].
Training procedures: As the ECMO system depends heavily on medical professionals to manually operate the machine and monitor it, it's essential to bring training programmes in regions of lower ECMO accessibility in order to increase the rate of ECMO implementation. The maintenance of exisiting systems will become more feasible with increased users.
Manivannan Mridini