The New Yorker:

A medical technology can keep people alive when they otherwise would have died. Where will it lead?

By Clayton Dalton

In November of 2022, a twenty-three-year-old woman named Shania Arms posted a video on TikTok. The footage shows her at a photo shoot, wearing jean cutoffs, black heels, and a crown of white flowers, lounging under palm trees. A building behind her with tall, rounded windows could be a hotel. But next to her, in every shot, is a metal trolley stacked with medical equipment. Two large plastic tubes, one cherry red, the other dark plum, loop from the trolley to Arms, entering her body beneath her clavicle. She has cystic fibrosis, a condition that damages the lungs. Hers are failing, and the machine on the trolley has replaced them.

The machine, called ecmo, which stands for extracorporeal membrane oxygenation, removes carbon dioxide from the blood and replaces it with oxygen. It can perform the work of the heart and lungs entirely outside the body. When Arms made the video, she had been on ecmo for forty-seven days, living in the I.C.U. of an Orlando hospital—the building behind her in the video—hoping for a lung transplant. Without ecmo, she would die. But owing to the complexity of the machine and its attendant risks—catastrophic bleeding, stroke, infection, malfunction—she couldn’t leave. She was waiting, stuck in a kind of limbo between life and death.

Although ecmo technology is more than half a century old, it was in some ways still considered an experimental treatment until recently. ecmo devices began to be used to replace lungs wrecked by covid-19; stories began to spread of incredible recoveries after as long as a hundred and forty-nine days on ecmo. Family members of covid patients called dozens of hospitals, hunting for the machines.

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