Many people struggled to breathe as the second wave of COVID-19 spread. As a result, doctors use Extracorporeal membrane oxygenation (EMCO) as one of their therapeutic options. When patients do not respond to any other therapeutic option, doctors turn to ECMO as a last resort. The demand for ECMO has significantly increased due to an increase in the number of critical COVID patients in the second wave. ECMO, contrary to common belief, is a “life-saving treatment” rather than a “cure.” It supports a patient’s heart and lungs and is used largely on individuals who require oxygen assistance. It oxygenates and eliminates carbon dioxide from the blood as it enters the machine. In an exclusive conversation with the Financial Express Online Dr. Rajesh Mohan Shetty, Lead Consultant, Department of Critical Care Medicine, Chief of Clinical Services, Manipal Hospital, Whitefield told more about ECMO and its usages. Excerpts:
What is ECMO?
ECMO stands for Extra Corporeal Membrane Oxygenation. This is one of the relatively new organ support options for critically ill patients. This has gained popularity recently especially in the current second wave of COVID pandemic.
When is ECMO treatment used?
ECMO is an artificial heart and lung support used for a patient who has lung and/ or heart disease and has failed to improve despite support from ventilators and inotropes. This is the treatment of the last option when everything else has failed.
What are the risk factors or side effects that are involved while undergoing ECMO treatment?
Side effects are mainly related to insertion of ECMO catheters into the blood vessels and running of the ECMO machine itself. Catheter related complications include bleeding and infection. ECMO related complications include consumption of platelets, need for anticoagulation, need for change of circuit if ECMO is required for a long time etc.
How has ECMO treatment helped in the 2nd wave of covid?
Many patients’ lives have been saved because of ECMO in the 2nd wave. Survival is reported between 30 to 50%. These are the patients who would not have survived otherwise. Many young people are alive now because of ECMO.
Can we count on ECMO to be a saviour for the expected 3rd wave?
ECMO will be a saviour for at least some of those patients who are suitable for this treatment option. Hopefully the 3rd wave will not come or if it comes it won’t be that devastating if most of the population is vaccinated, but if it does come ECMO will save many lives.
Why are ECMO facilities so limited in India? Elaborate on the expertise required.
Three reasons- cost, availability of machines and expertise. ECMO circuit costs around 2 Lakh rupees which makes it an expensive treatment. Also expertise available at the moment is rare as it is relatively new treatment. ISCCM has started an ECMO fellowship which is based in Bangalore. Hopefully we will have more experts in this field in the near future. Demand for ECMO was more this year than expected. We will be better prepared in the future as more machines have been acquired.
How much is the success rate of ECMO treatment, during and pre-Covid?
Outcome depends on many factors including the centre and expertise. During pre-COVID and the first wave of COVID pandemic success rate was around 70% internationally. For the second wave it is between 30-50% as the Delta variant turned out to be more virulent. We are fortunate to have been able to produce outcomes comparable to international standards at Manipal.
How long can a person be on an ECMO machine?
There is no time limit. As long as underlying disease is reversible, ECMO can be continued as long as required.
ECMO is saving the very sickest patients from Covid-19. Comment
Yes. We had many survivors in Manipal. One of our patients was able to conduct his daughter’s wedding after discharge from the hospital. Another young Ayurvedic doctor will be able to go back to work when she completely recovers in a few months’ time. Many more patients would have not been alive today without ECMO.
Future of ECMO in India.
Use of ECMO is expected to increase exponentially both in India and internationally. As we have become more comfortable using it more indications have become available and hopefully more lives will be saved.
ECMO in infants and adults
Actually ECMO has been in use in infants much earlier compared to Adults. Alsom outcomes are much better for children compared to adults with ECMO.