ECMO (Extracorporeal membrane oxygenation)

ECMO (Extracorporeal membrane oxygenation) is a life supporting device which is used for life threatening lungs and heart problems, such as severe lung damage by infection or shock due to Heart attack.

ECMO substitutes the function of heart and lungs, which is normally few days to weeks, so that these organs can recover. It doesn't cure the disease. It is also used as a bridge to heart and lung transplant.

These patients are cared for in ICU hospitals as they need close monitoring of their heart rate, blood pressure, oxygen levels and other vital parameters.

How does ECMO work

It involves placing tubes (cannula) in large veins and arteries located in neck, chest, and legs which connect the patient to the ECMO machine. Blood is pumped outside of the body to the ECMO machine where it is oxygenated and carbon dioxide removed. The blood is then returned to the body from where it is distributed to the various tissues.

There are two types of ECMO 

1: VENO—VENOUS: It takes blood from one of the veins and returns to the vein. It supports lung function

2: VENO-ARTERIAL: It takes blood from the vein and returns to the artery. This supports both lung and heart function.

Lung problems that may need use of ECMO

• Pneumonia, not manageable with ventilator
• Acute respiratory distress syndrome (ARDS), Lung Failure
• Blockage in a pulmonary artery in the lungs (pulmonary embolism)
• Defect in the diaphragm (congenital diaphragmatic hernia)
• Flu (influenza), Pneumonia, Hantavirus pulmonary syndrome
• High blood pressure in the lungs (pulmonary hypertension)
• Trauma to chest wall and lungs
• High risk surgery on and around airways and lungs

Cardiac arrest may need ECMO (ECPR) if due to

• MI (myocardial infarction)
• Pulmonary embolism
• Refractory ventricular fibrillation
• Cardiac injury
• Myocarditis
• Cardiomyopathy
• Drug intoxications

How Long ECMO is needed?

ECMO is used until the heart or lungs recover or until treatment is no longer effective, which can take days or weeks. The duration of ECMO varies based on the person age, original diagnosis, and individual factors. It typically require ECMO for an average of 7-14 days, but it can extend to 21 days or more. 

Factors influencing the length of ECMO treatment include:

• The type and severity of lung or heart disease,
• Pre-existing lung damage, and any complications that arise during ECMO.

ECMO milestones at FORTIS HOSPITAL, GURGAON 

We have been running ECMO services since 2015 and are the only centre in India to run an ELSO certified ECMO training course for doctors and nurses.

First centre in north India to start ECMO programs

First centre in north India to ELSO certified training for doctors perfusionist nurses from India and Asian countries

First centre to start ECMO Retrival service in North India (air and Land)

ECMO services at FORTIS Hospital, Gurgaon 

Since 2015 we have done over 200 cases involving various life-threatening lungs and heart diseases.

We have 24/7 ECMO team on call which specializes in ECMO retrieval service by road and air transport. Our team, which includes critical care physicians trained in ECMO, critical care nurses and a perfusionist .

Our team does a detailed pre ECMO assessment to ascertain which patient is the right candidate for ECMO and counsel the family about the pros and cons of this therapy.

After this our team goes to the hospital where your patient is, puts the patient on ECMO and bring them to our hospital for further management . 

Our survival rate on ECMO is around 40 % which varies from patient to patient.

A specially trained care team

All ECMO team members have received specialty training in caring for people with complex or serious conditions. The care team is made up of:

• Critical care physicians.
• Specialty-trained nurses (ECMO specialists).
• Perfusionists.
• Registered nurses.
• Pharmacists.
• Physical therapists.
• Pulmonologist 

What are the risks associated with ECMO 

When someone needs ECMO, it means they are sick and could die without it. But there are dangers involved in this treatment.

The doctor in charge of ECMO will talk to you about these risks:

• Bleeding: To stop the blood from clotting inside the ECMO machine, a medicine called Heparin is used. The amount of Heparin given is watched carefully, but sometimes bleeding can still happen. Bleeding can occur in different parts of the body, but it’s especially dangerous if it happens around the brain. This could cause long-term damage to the brain.

If bleeding becomes severe, one or more of the following measures might be required:

• Frequent transfusions of blood
• Additional surgeries to manage the bleeding
• Stopping the ECMO treatment
• Blood Clots: Small clots in the bloodstream can harm vital organs like the brain or kidneys.
• ECMO Equipment Malfunction: Though rare, the ECMO system’s equipment can fail, but there’s a specialist available around the clock to respond quickly.
• Stroke: Bleeding or blood clots in the brain can lead to a stroke. In some cases, a surgical procedure involves tying off one carotid artery.
• Other Complications: Connecting the ECMO machine may result in infection, bleeding, or vocal cord injury. Heart or lung function may not improve, and severe bloodstream infections can damage vital organs.
• Blood Transfusion: Very rarely, serious reactions like shock or kidney failure can occur. There’s a slight risk of acquiring infectious diseases, although improved donor screening and blood testing reduce such risks.