[drxzcl]

Not to downplay the dilemmas we face today, it seems to me that the main problem is that the machine is too expensive, too complicated and too large to serve as a permanent heart/lung replacement.

We have an excellent record of making machines smaller, cheaper and simpler to operate. This machine will be the pacemaker of the future.

[timr]

It has very little to do with the size and expense of the machine itself. ECMO requires 24/7 human maintenance because humans are messy dynamic meatbags, and tubes clog with clots, blood changes pH, people have an annoying tendency to move, etc. Every hospital with ECMO literally has "an ECMO team" to support the thing. It's mind-bogglingly expensive in terms of human capital.

Other people on this thread are trying to imply that these things are like artificial hearts. That is true only in that the heart is one of the things that an ECMO machine attempts to replace. We don't have anything like an implantable artificial lung.

[Teever]

I used to deliver food in a hospital. I got to know a guy who had emphysema or something like that I served him food off and on for about two years. One day I saw that he disappeared and I thought he was dead, but he popped up a few days later with some gnarly staples on his chest and a much less hoarse voice.

After a few false promises over the years he finally got a new set of lungs, they gave him a new heart too because his was fucked from the strain that his damage lungs had put on it.

IIRC, he got a new set of lungs and a heart on Wednesday, was sitting up by Friday and was eating the pureed food that I served him by Saturday. I had no idea the recovery time was so fast for a procedure that involves splitting your chest open, ripping your heart and lungs out and sticking new ones in there and sewing it back up.

The unfortunate part of this all is that he probably isn't still alive today as I understand it because lung transplants still have poor prognosis, unlike something like a heart transplant. I believe it's due to increased infection inherent in the nature of the organ -- it makes direct contact with outside air and has an insane surface area, couple that with immunosuppressive drugs and the risk of infection you're looking at an increased chance of death.

But if we had some way to grow perfect stem cell organs for situations like this or ECMO that can keep a baby alive it changes everything. The US spends 1% of the GDP on dialysis alone, it's mind boggling.

We've found these treatments like ECMO that 'work' in a very tenuous sense that they can sometimes if you squint hard enough produce desirable results but it's in no way sustainable or scaleable.

Any technology that pushes us towards a future where we can grow and store organs will change the face of humanity in so many ways. It'll free up so many resources that we can then focus on other game-changing medical innovations, which I think will lead to a snowball effect of the eradication of so many maladies and a fundamental shift in the human condition.

[dools]

Yeah but tech has 3 stages:

1) Make it work 2) Make it good 3) Make it scale

If this thing works, then probably it's in the process of being made good, and then it can enter the third phase.

It'll be implantable in 50 - 100 years if it works at all now.

[iancmceachern]

Yes and no.

We had the first artificial hearts 60 years ago, and were convinced they were a decade away from mass adoption then.

As another commenter posted, the human body is complicated.

We now take knowledge for granted that we didn't even know we didn't know when I started working on these things.

In order to solve the problem we have to just build hardware and put in in people, see how it goes and then iterate on it. This cycle takes years because it takes 2-10 years to get each device through design, regulatory, release. Sometimes once we get deep into it we realize that what we set out to do isn't even possible for reasons we didn't even know when we started. It's like you are having to make up new Greek letters for all the factors in the new equations you discover. It's hard to predict.

Source - I've designed many medical devices including several blood pumps and LVADs.

[dools]

Okay so 100 - 200 years then ;)

[jonah]

TFA says that they're currently working on a portable (external) lung replacement[0]. I see no reason that it couldn't be installed in the chest cavity with a port for the O2 bottle connection.

[0] https://archive.ph/0GP4F#selection-1103.0-1110.0:~:text=To%2....

[timr]

Even if "they're currently working on" meant "it's available now or practical in the near future" (it doesn't), that doesn't affect what I said about the immense costs involved.

The portability of the device is not the core issue here. It's a bit like arguing that you can build a quantum computer today, so therefore we'll all have one on our desktop soon.

[xattt]

Extracorporeal livers were being explored in the 1960s. It was advanced enough that it was included in a contemporary Time-Life book. Unfortunately, experimental success was not observed and the idea was shelved.

[aidenn0]

Nobody has said "soon" I think you inferred meaning that wasn't there.

[xboxnolifes]

A lab "working" on something is the equivalent of not having it. It should be not be read as an inevitable outcome.

[iancmceachern]

Exactly, here are some more: Fusion Artificial XYZ Fuel that comes from X Airships

[credit_guy]

Exactly. This is progress. There is no ethical dilemma here, whatsoever. This is a technology that is keeping people alive. It's bulky, expensive, dangerous, etc, etc. But those things are not set in stone. In time it will become small, affordable, safe, etc. Until then, every little step should be celebrated.

[iancmceachern]

It will, you are right. Anyone who wants to design hardware in the space feel free to reach out.

[flakeoil]

> This is a technology that is keeping people alive.

And in the meantime, let's have everyone who wants to walk around with a loaded gun.

[Animats]

Yes. The first recipient of an artificial heart was tethered to a sizable amount of hardware and confined to an ICU. Now, implanted artificial hearts are regularly used.

[sxg]

That's definitely not the main problem. Risk of intracranial hemorrhage/strokes and other complications make it problematic.

[saurik]

But that isn't the problem from the article--the ethical issue of how to deal with a ton of people who are being kept alive on a "bridge to nowhere" when the machines might could be used in the interim to save many more people--as if you have an intracranial hemorrhage you are going to start down the road to actually dying. (And the article also talks about attempts to improve the bleeding problem anyway.)

[toth]

To me it sounded like part of the problem is that people on ECMO cannot leave the ICU because at any moment they might have a complication that requires immediate emergency care.

So it's not enough to make them smaller and cheaper, they also have to be made much less prone to these complications. I am sure that will happen in time, but I am also sure we'll be able to grow people new lungs in time

[FireBeyond]

Critical care paramedic: that's very much the bigger issue. Some life flight helicopters are being fitted for ECMO and there is NOT much space in a helicopter, once you fit in two providers, a patient on a gurney and care equipment (most HEMS units are Bell 429s and EC/H-135s - MSP uses much larger AW-139s).

https://live.staticflickr.com/3142/2639039443_ba623ddca0_b.j... shows the working space on a -135. Note that access to most of the patient is heavily restricted - only chest and head, really.

Still, to be clear, we are not really at the 'portable' stage either. There's about 65lb of equipment needed for an ECMO patient just for the ECMO itself, beyond other things like Lifepaks for monitoring.

[iancmceachern]

Thank yoi for what you do.

If anyone wants to design a portable, integrated ECMO system reach out.