Years ago I came across an article in The Lancet Respiratory Medicine which radicalized me. It was the story of a 17-year-old boy in Boston whose lungs had failed and was being sustained by ECMO (extracorporeal membrane oxygenation) while awaiting a transplant.
While waiting, he was diagnosed with a complication that took him off the transplant list. Here was a teenager, awake in the ICU, talking to friends and doing homework, but who was now on a bridge to nowhere, as the doctors would describe it. “Although ECMO had originally been intended solely as a bridge therapy, in this patient it had become a successful destination therapy,” they wrote. “Concerns arose about the ethical and psychological implications of removing ECMO from a patient who wanted it to continue. Should—or would—clinicians be willing to proceed with the termination of life support in the face of a patient and family who believed that the patient’s life was still of value to him?”
Their solution was to stop changing the oxygenator filter, which clotted about a week later resulting in the patient’s death.
This wasn’t a one off: it turns out that if you search PubMed, a database of scientific literature, for the phrase “ECMO ethical dilemma,” there are dozens of results.
ECMO is an incredible technology, but the systems we have today are only temporary bridges to recovery or transplantation and are unable to routinely function as long-term support. They tether patients to the ICU and require constant manual adjustments to the system like regulating blood pressure or replacing oxygen filters; the complexity demands specialized team members and creates steep learning curves. Patients are removed because the economics and operational burden become untenable.
What We’re Building
Vessel is a research program: we have a ways to go to build the products we are imagining. The idea behind the Vessel project has actually been on our roadmap at Science since the beginning of the company, and over the last few years we’ve built a prototype perfusion circuit from scratch with a few unique elements. When we hit regular 48-hour perfusion times earlier this year we knew we had enough information to make a larger bet on the concept, and we raised some money to dedicate to this.
Our goal is to miniaturize and ruggedize ECMO such that you could check a kidney as luggage on a commercial flight across the country or have a patient take home a reasonably-priced backpack rather than being tethered to a scarce ICU suite. Making this possible will require innovating on all aspects of the system, from improved pumps to safe and robust percutaneous connectors, but allows us a substantial paradigm shift from conventional medicine to a world of swappable parts. From better low hemolysis blood pumps to miniaturizing dual-circulation MARS-type dialysis to real-time closed-loop blood parameter monitoring, this work requires a team with deep expertise across engineering, software, and biology.
What’s Next
We’re extending how long life can be sustained on perfusion—moving from days to weeks, and eventually, months, years, or indefinitely. When patients can remain safely on mechanical life support sustainably, we will fundamentally change the economic calculus of critical care and how we approach some serious conditions. The question shouldn’t be whether we can afford to keep someone alive: it should be whether the technology allows us to, and the reality of what is technically possible now would surprise many people.
At Science, we’ve had three major elements of our pipeline from day one: restoring vision to the blind through the retina, developing interhemispheric-class biohybrid neural interfaces, and extending life via machine perfusion. These three programs form a specific contrarian take on the future of healthcare and healthspan extension and we are encouraged by our early progress.
If you’re interested in developing technology that create options for patients who have hit the conventional end of the road, please consider a career at Science.
