ECMO Services and Treatment
Extracorporeal Membrane Oxygenation helps deliver oxygen (and removes carbon dioxide) through blood, used in selected patients with cardiac or respiratory failure to support the body when the lungs or heart are unable to do so.
Extracorporeal membrane oxygenation (ECMO) helps replace the function of the lungs and heart when they are not able to function normally, even with medication or the assistance of a ventilator. This happens until the heart and lungs can be treated until they resume their normal function. In extracorporeal membrane oxygenation or ECMO support, blood is pumped outside of the body to a heart-lung machine that removes carbon dioxide and sends oxygen-filled blood back to tissues in the body. During the ECMO procedure, blood flows from the right side of the heart to the membrane oxygenator in a Heart-Lung machine, and then is rewarmed and sent back to the body. In the meanwhile the ECMO equipment will pump blood for the heart and will exchange oxygen for the lungs. The ECMO removes blood from the body and moves it through a pump which is then filtered through a membrane oxygenator that adds oxygen and removes carbon dioxide. A specialist doctor will place the cannula into a large vein and a large artery at the leg or neck.
When is ECMO Used?
ECMO therapy is essentially used during the critical condition of a patient, when the heart and lungs need assistance to heal while the blood bypasses the heart and lungs. It may be used for treatment and care for COVID-19, ARDS and other infections and the technique is known to save up to half of the critically ill Covid-19 patients for whom ventilation does not work.
- Patients needing respiratory support only.
- Patients with severe symptoms who need both cardiac and respiratory support
- ECMO may even be indicated while CPR (cardiopulmonary resuscitation) is being carried out.
Outcomes without the procedure
If the patient does not have ECMO treatment, they may experience brain death due to lack of oxygen and can die if their heart and lungs do not work.
Why is the ECMO procedure done?
ECMO is done for the below mentioned conditions;
- Critically ill patients with conditions of the heart and lungs
- Patients who are waiting for a heart transplant
- Patients who are recovering from a heart transplant.
ECMO is usually an option when other life support measures may not have worked. ECMO does not treat or cure a disease, but can help you when your body temporarily can’t provide your tissues with enough oxygen.
How ECMO procedure works?
Heart conditions in which ECMO is used
- Transplant complications (post operation)
- Life-threatening response to infection (sepsis)
- Acute myocardial infarction i.e. Heart attack
- Heart muscle disease (decompensated cardiomyopathy)
- Inflammation of the heart muscle (myocarditis)
- Low body temperature (severe hypothermia)
- Cardiogenic shock (shock caused by the heart while not pumping enough blood)
Lung (pulmonary) conditions in which ECMO is used
- Respiratory failure
- Acute respiratory distress syndrome (ARDS)
- Blocked pulmonary artery in the lungs (Pulmonary embolism)
- Coronavirus disease 2019 (COVID-19)
- Congenital diaphragmatic hernia (defect in the diaphragm)
- Meconium aspiration i.e. when the fetus inhales waste products in the womb
- Flu or influenza
- Hantavirus pulmonary syndrome
- Pulmonary hypertension (High blood pressure in the lungs)
Patient outcomes with ECMO are dependent on the seriousness of the health condition for resulting in the use of this procedure. A specialist doctor or surgeon can explain how helpful ECMO can be in any given circumstance.
Why Yashoda Hospitals?
- Specialist ECMO trained intensivists, Perfusionists, Nurses available 24/7
- Dedicated 20 beds
- Laminar flow ECMO ICU
- Bridge to transplant expertise and world class Lung transplant team on site
- 50 air ambulance transfers (approximately) with onsite and off-site ECMO cannulation support
Our Multi- disciplinary Team for ECMO
Dr. Srinivas Rajagopala
MD (Internal Medicine), DM (Pulmonary & Critical Care Med), PGI Chandigarh Fellowship in Lung Transplantation, Toronto
Director - Transplant Pulmonology
FAQ’S About ECMO
What is ECMO?
ECMO stands for Extracorporeal Membrane Oxygenation which means that the blood circulates outside the body. Membrane oxygenation means that the ECMO machine helps deliver oxygen (and removes carbon dioxide) through blood. ECMO is used in selected patients with cardiac or respiratory failure with the main goal of supporting the body when the lungs or heart are unable to do so. The ECMO machine works on behalf of the lungs and heart, so the patient can recover completely or be bridged to a decision on the best treatment modality, which typically includes a device (for heart) or transplant.
Who benefits from the use of ECMO?
The conditions in which we use ECMO vary widely, but includes acute respiratory failure due to severe pneumonia, severe forms of the acute respiratory distress syndrome (ARDS), and severe asthma (status asthmaticus). Acute respiratory failure due to pandemic influenza virus (pdm H1N1) and more recently, the novel coronavirus (COVID-19) has made the use of ECMO in this setting more common. Cardiac support by ECMO is useful in acute coronary syndrome with cardiogenic shock (severe heart attack), acute decompensated heart failure, decompensation of pulmonary hypertension, massive pulmonary embolism (blood clot in the lungs). Severe Myocarditis and Postcardiotomy Shock (a shock following open heart surgery). In our center at Yashoda Hospitals Hyderabad, we also use ECMO for acute deterioration in patients listed for heart or lung transplantation as a bridge to device or heart and lung transplantation
Who determines which patients are eligible for ECMO?
At Yashoda Hospitals Hyderabad, a dedicated Multidisciplinary team of ECMO clinicians consisting of critical care physicians and specialist surgeons determine if a patient is eligible for ECMO. Each patient’s case is considered individually and a customised treatment plan is curated based on their medical condition, the emphasis being on “awake ECMO” with early “wake up” and mobilisation of patients while on ECMO. While we started this in our lung transplant bridging program, we are now using this approach in all patients to preserve neuromuscular function.
Is ECMO a cure?
We have witnessed many cases where lives were saved at Yashoda Hospitals Hyderabad, when all other treatments had failed. Without the use of ECMO, there was a probability that the patient’s symptoms could have changed drastically for a fatal outcome. Nevertheless, ECMO is not a cure or a gold standard for the underlying illnesses, and it only provides support for the body during the critical condition and until the lungs or heart recovers with effective therapy and rehabilitation.
Has ECMO been life-saving for COVID-19 patients?
Our team has successfully used ECMO to support several critically ill COVID-19 patients at Yashoda hospitals, Secunderabad. A recent study also demonstrates similar survival rates in ECMO patients with severe respiratory or cardiac failure due to COVID-19, and patients with other causes of respiratory failure.
Are there any other options instead of ECMO?
ECMO is considered as a “rescue” or “salvage” method when all other medical treatments have failed. So, typically, there is no other option available.
Is ECMO safe?
ECMO is a potentially life-saving yet complex procedure and is not one without any risks. Considering when a patient is sick enough to require ECMO, more often than not, the potential benefits outweigh the risks. Our team of specialists are skilled at minimizing the risks of ECMO when needed.
Who will take care of me while I am on ECMO?
Every ECMO patient at Yashoda Hospitals Hyderabad will be taken care of by a multidisciplinary team with Critical care physicians, Surgeons, Perfusionists, expert Nurses, Pharmacists, Respiratory therapists and Rehabilitation therapists. The focus of all of these experts is good ECMO care, in a holistic manner and early rehabilitation when and where possible.
Where does the ECMO procedure occur?
The surgical cannulation typically occurs at the patient’s bedside. Our surgeons are often called to place a patient on ECMO at a referring Hospital and provide safe transfer back to Yashoda Hospitals supposing the patient is too sick to travel without ECMO
How long is the patient usually on ECMO?
The duration of time someone is on ECMO significantly varies based on the type and severity of the underlying illness and other factors like age and overall degree of the health condition. Typically, ECMO is necessitated for about 2 weeks for an acute illness as a bridge to recovery.
Our experts assess and analyse the patient’s condition (severity) or disease before diagnosing and treating all patients with their or their families consent.