Dr. Yigal Kassif – Has Covid changed the game?
The COVID-19 pandemic placed extraordinary pressure on critical care teams and forced clinicians worldwide to rethink how severe respiratory failure is managed. In this lecture, Dr. Yigal Kassif, cardiac surgeon at Sheba Medical Center and Chairman of the Israeli Society for ECMO, discusses whether COVID-19 changed the role of advanced respiratory support, including ECMO, mechanical ventilation, and earlier intervention strategies for patients with severe hypoxemia.
ECMO as a Last-Resort Life Support System
ECMO, or extracorporeal membrane oxygenation, is a life-support system used in cases of severe cardiac, respiratory, or combined failure. As Dr. Kassif explains, ECMO does not cure the underlying condition; rather, it provides temporary support by enabling gas exchange and tissue reperfusion while the patient’s organs are given time to recover. In this sense, ECMO serves as a bridge in critical care, often when other treatment options have failed.
COVID-19 and the Pressure on Critical Care Systems
During the COVID-19 pandemic, hospitals faced an extraordinary increase in critically ill patients with severe respiratory failure. In Israel, ECMO use expanded across multiple waves of the pandemic, creating major challenges around machine availability, trained staff, patient transfers, and ICU capacity. Dr. Kassif describes how the crisis required not only advanced technology, but also national coordination, rapid training, and careful management of limited critical care resources.
Lessons in Training, Logistics and National Preparedness
One of the key lessons from the COVID-19 era was that ECMO capacity depends on much more than the number of available machines. Dr. Kassif highlights the importance of training nurses, physicians and perfusionists, creating ECMO schools, and building systems for patient and equipment transfers. These operational lessons helped support access to ECMO during periods of extreme pressure on hospitals and intensive care units.
Awake ECMO and the Effort to Avoid Mechanical Ventilation
A major clinical insight discussed in the lecture is the use of awake ECMO, an approach that may help avoid or shorten invasive mechanical ventilation in selected patients. Avoiding mechanical ventilation can reduce the need for anesthesia, support patient cooperation, help preserve muscle function, and potentially reduce infection-related risks. This reflects a broader clinical interest in providing respiratory support earlier, before patients deteriorate to the most severe stages of respiratory failure.
The Potential Role of Earlier Partial Respiratory Support
The lecture also points toward the potential value of partial-flow respiratory support technologies designed for earlier intervention. Rather than waiting until a patient reaches the point of complete respiratory failure, partial support may offer a way to assist gas exchange while reducing reliance on aggressive mechanical ventilation. As Dr. Kassif notes, future devices in this field must prioritize safety, including reducing risks such as clotting and hemolysis, while supporting patients who are deteriorating despite maximal non-invasive care.
Watch the full lecture to hear Dr. Kassif’s perspective on how COVID-19 reshaped respiratory support and what it may mean for the future of critical care.
