The biggest cause of death in Australia is a heart attack. It kills about 30,000 people a year and ninety-five percent of cardiac arrest patients die before they reach hospital. Six rapid response New South Wales ambulances are now equipped with a " Lucas machine " trial and it is expected that this will boost the recovery rate exponentially.
The recommended response to a heart attack is to apply chest compression but that depends on the skill of the bystander and the ability of being able to deliver constant strokes until help arrives and during the journey to hospital. The Lucas machine is a battery operated unit which is attached to the patient and applies a constant hundred compressions per minute by way of a suction cap on the chest above the heart. The Lucas machine costs about $ 15,000 and it is hoped that they will eventually be installed in all of the eight hundred and fifty ambulances serving New South Wales.
If a Lucas machine is available in ambulances it is able to deliver chest compressions beyond the ability and strength of a paramedic, and in cases where country ambulances are served by a single attendant/driver.
When the patient arrives at the hospital emergency room the availability of an ECMO machine would revive even those considered clinically dead. ECMO stands for " Extracorporeal Membrane Oxygenation " and tubes are inserted into arteries in either the patients neck or groin and the blood drained, oxygen added and carbon dioxide removed, the blood heated to body temperature - and returned to the body. Basically, it replicates the load carried by a beating heart and allows medical intervention to find and repair the cause of the heart attack.
The availability of ECMO machines have doctors describing the treatment as " bringing people back from the dead " where a heart attack is being treated in comparison to the twenty minutes resuscitation usual in such cases.
Hospital administrators warn that adding ECMO to the facilities available in emergency rooms will certainly save lives, but that saving will be at the expanse of waiting times and it will create a huge blowout in operating costs. It will require extensive staff training to process the use of an ECMO machine and to ensure sterility many of the parts used on each patient will be single use only and discarded. The patient will require intensive care and that usually amounts to a costing of a hundred thousand dollars day - which would be the added cost of each life saved.
They warn that it is not possible to simply add " Lucas " to the ambulance fleet and bring more patients alive to emergency rooms and have them attached to ECMO machines and expect that to be achieved with the same staff level and with the same operating budget that is now applicable.
We are accustomed to what is often described as " miracle treatment " where specialised doctors and machines can keep a dead human body functioning until decisions are made by family to " turn off the machine " and let death naturally occur. In many cases, decisions on the donation of body parts hinge on such machines keeping them viable until arrangements are in place.
What " Lucas " and " ECMO " deliver is a more compact version of that miracle treatment that can be incorporated in the emergency room of hospitals to make heart attack resuscitation simply a general procedure available to all.
The medical profession is warning us that it is unrealistic to expect ongoing medical miracles to become universally available without us dipping into our pocket and funding the cost. That seems to be a message few people want to hear !
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