During the COVID-19 outbreak, Takayuki Ogura would often search for a hospital that could take the most critical patients, but couldn't find one that would accept them.

He was the point man of the ECMOnet, a volunteer group of intensive care doctors and other medical staff, which arranged to transport and hospitalize patients with severe symptoms in need of treatment.

So, Ogura, head of the medical emergency center at Saiseikai Utsunomiya Hospital, had to select patients for transfer who were likely to survive, including those who had been on a ventilator for no longer than 10 days.

“I had to make difficult decisions,” he added.

For COVID-19 patients in dire straits, their last lifeline often comes through being put on an extracorporeal membrane oxygenation, an ECMO lung bypass machine.

However, with only about 200 of the life-support units available in Tokyo, it's often a race for doctors such as Ogura to find one for patients in critical condition.

Speeding to the rescue is an ECMO-equipped vehicle that can transport these patients safely to a medical facility where the life-saving equipment is available.

In late February, doctors with ECMOnet transferred a patient about 350 kilometers from Nagoya to Tokyo via an ECMO vehicle.

Osamu Nishida, president of the Japanese Society of Intensive Care Medicine (JSICM), said the ECMO-equipped vehicle has great potential.

An ECMO vehicle can transfer patients to wider areas, and patients will have more choices to select medical institutions for their hospitalization.

Medical institutions can maintain sufficient medical staff and beds in their respective intensive care units by transferring critical patients.

“Even if there is only one ECMO vehicle available for one medical zone, the area will have a much less medical burden,” Nishida said. “An ECMO vehicle will be the quickest and the most effective measure to protect the capacity of ICUs.”

The Japan Medical Association urged the central government in May to deploy more ECOM vehicles across the nation. The association hopes that one ECMO vehicle will be placed at each leading medical institution in regions from Hokkaido to Okinawa Prefecture. A total of 20 vehicles are forecast to be equipped across Japan.

The special ECMO vehicle is 1.1 times larger than conventional emergency vehicles. It has enough space to accommodate multiple doctors and clinical technicians. It also has sufficient batteries for powering an ECMO, which helps the treatment for patients who are infected with the novel coronavirus and have severe symptoms.

An ECMO removes carbon dioxide from blood taken out of blood vessels and adds oxygen and circulates it back to the blood vessels.

It is effective in helping patients recover lung functioning that has been weakened due to COVID-19.

However, to operate an ECMO, two thick tubes need to be inserted into a patient, so there are risks of bleeding or infection. Inaddition to facilities such as ICUs, skilled and experienced medical staff are necessary for the proper operation of an ECMO.

Only a limited number of medical institutions can operate the equipment properly.

At times during the first infection wave in the spring, there were instances that an ECMO could not be utilized even though it was available. In normal times, an ECMO is often used for a short period during heart surgeries.

However, the life-support machines are now used for the long-term treatment of COVID-19 patients. Although there are about 200 ECMO units in Tokyo, fewer machines could be used for COVID-19 patients due to the lack of doctors who can operate them.

ECMOnet is holding training sessions across the nation to increase the number of medical staff who can operate the equipment.

The survival rate of patients using an ECMO unit in Japan exceeded 70 percent as of August, higher than those of other countries.

The first infection wave swamped Tokyo in April, with the number of infected patients in hospital in the capital surpassing 2,800 at one point. The number of patients with severe symptoms also increased.

According to the database of three medical societies, including the JSICM, as of April 24, in the capital the highest number of 89 patients were in intensive care on ECMO or ventilator units. As of Aug. 23, the number of such patients was 28.

According to research conducted by JSICM in February, there are at least 1,400 ECMO units in Japan, but Tokushima and Fukui prefectures only have 10 units or fewer.

The availability of ECMO differs greatly among regions. Although the number of ECMOs are increasing, it will be difficult to treat patients with severe symptoms if their number also soars.

Therefore, the transport of patients in wider areas is promising because they can be transferred to medical institutions in neighboring prefectures.