Extracorporeal Membrane Oxygenation Treatment in India

Extracorporeal Membrane Oxygenation (ECMO)

Extracorporeal membrane oxygenation (ECMO) is an effective technique to provide emergency mechanical pulmonary and circulatory assistance for patients with cardiogenic shock or respiratory failure refractory to conventional medical therapies. It has been successfully used as a bridge to heart and lung recovery, heart transplantation or the implantation of a Left Ventricular Assist Device (LVAD).

ECMO stands for extracorporeal membrane oxygenation. In other words, it is very similar to a heart-lung bypass machine used for open heart surgeries.

When the patient is placed on ECMO, his/her blood recieves oxygen from an artificial lung in the ECMO circuit. Thus the oxygen needs of the body are maintained till the patients’ heart and lungs are able to work on their own again.

There are two types namely, Veno-Venous (V-V) ECMO and Arterio-Venous (A-V) ECMO. Veno-Venous ECMO consists of a single cannula which is really two catheters in one and is principally used in medical conditions. Arterio-Venous Bypass involves two cannulae. The type of ECMO used depends on the patient and the type of illness they have.

During a disease process, an organ or multiple organs are damaged and need time to recover and heal with appropriate medical therapy. If under these conditions the organ has to keep functioning, it worsens the burden on the organ. For e.g. a weak heart failing after corrective heart surgery needs time to recover. ECMO functions as an artificial heart and lung, and thus, gives rest or recovery time to the heart +/- lungs.

A tube (catheter) is placed in a large vein (in the neck or groin of the patient) and deoxygenated blood or impure blood is drained and run through a pump (external or artificial heart) and an oxygenator (artificial or external lung) along with a sweep gas flow system which will entrain oxygen and remove carbon dioxide from this blood. This oxygenated or pure blood will look bright red and is pumped back into the patient at the same rate as the patient’s heart rate.

The ECMO machine

The machine components include

  • TUBINGS which act as pathway to take blood from the child to the machine and back to the child.
  • PUMP to take and give blood to the child.
  • MEMBRANE to which the pump pushes blood for removing carbon dioxide and adding oxygen.
  • HEMOTHERM to warm the blood to maintain body temperature.

The devices and circuits used for ECMO have changed over the years and safer material are being now used which are also long-lasting preventing frequent change of circuits. This was a common problem in the past due to complications such as bleeding and increased need of blood products. These problems have now been minimised to a great deal and the implementation of ECMO is also now much safer in skilled and trained hands, thus, reducing procedure-related complications in experienced units.

ECMO is used when the patient is suffering from a life-threatening systemic illness like severe pneumonia (ARDS), heart failure, cardiorespiratory failure (reversible) related to infection or Surgery,   where all other forms of medical therapy have failed to cause significant improvement.

At the same time, it needs to be judiciously and promptly instituted in conditions which are known to be reversible with time and appropriate medical therapy (infection, pneumonia, reversible heart dysfunction). It has to be remembered that ECMO is not a curative measure but helps in resting the heart and/ or lungs that are diseased giving them time to recover.

ECMO is an expensive and a labor-intensive therapy. Institution of ECMO involves trained surgeons, anaesthetists, intensivists, perfusionists, nurses and efficient and prompt laboratory services. It involves frequent blood investigations and blood product use. However, today it is becoming an affordable modality of treatment in the Indian scenario too today.

We have an active ECMO programme with a dedicated team. Our ECMO experience is gradually accruing.

Managing a patient on ECMO is a multidisciplinary team effort.
Our Team consist of:

  • Cardiac surgeon
  • Cardiac Anaesthesiologist
  • Intensivist.
  • Cardiologist
  • Perfusionist
  • Cardiac Nurse