All You Need to Know About ECMO

Bengaluru, December 22nd, 2016: Thirty six year old Lokesh is lucky to be alive as he survived an advanced stage of respiratory failure. He thanks not only his doctor, but also a life-saving machine called Extra Corporeal Membrane Oxygenation (ECMO).

This and much more was discussed today at a press dialogue on myths and facts about ECMO conducted by Vikram Hospital, Bengaluru’s trusted quaternary care and multi-specialty health facility. The objective of the dialogue was to improve the understanding of ECMO and raise the level of awareness about its role in critical care among the masses.

ECMO is a form of extracorporeal life support where an external artificial circuit carries venous blood from the patient to a gas exchange device (oxygenator) where blood becomes enriched with oxygen and has carbon dioxide removed. This blood then re- enters the patient circulation.. 

Speaking on the occasion, Dr.Vijaykumar Anaiahreddy, Consultant Critical Care, Vikram Hospital, Bengaluru said "ECMO for adults is a new modality treatment available only in very few centre’s across the globe. Awareness about it is low. It can provide cardiac and respiratory support temporarily to patients whose heart and lungs are so severely diseased that they can no longer serve their function while allowing the underlying disease process to heal." 

The goal of ECMO is adequate oxygenation of the cell and tissue perfusion to decrease further lung damage by higher ventilator settings, to reduce toxicity of inotropes & vasopressors and to provide rest to the heart and lung to promote healing.

There are two types of ECMO – VV-ECMO and VA – ECMO. In VV-ECMO, venous blood is accessed from the large central veins, pumped through the oxygenator and returned to the venous system near the right atrium. It provides support for severe respiratory failure. It can be Femoro-Femoral or Femoro-Jugular or Dual lumen Bicaval cannula (Avalon). 

In case of VA – ECMO, venous blood is accessed from the large central veins, pumped through the oxygenator and returned to the systemic arterial system in the aorta. Recirculation cannot occur in VA ECMO. Its pump provides cardiac support for severe cardiac failure (with or without associated respiratory failure). 

The overallsurvival rate of a patient on ECMO is about 60% and among thouse who are onVV_ECMO for refractory respiratory failure, the survival rates are much better.

Thislife-saving machine is used in cases of reversible causes of refractoryrespiratory failure, refractory hypercapnic respiratory failure, refractorycardiogenic shock (myocarditis, decompensated cardiomyopathy, acute coronarysyndrome), post cardiac arrest failure to wean from cardiopulmonary bypassafter cardiac surgery, as a bridge to either cardiac transplantation orplacement of a ventricular assist device and poisoning or certain drugoverdose. 

Dr.GaneshakrishnanIyer, Consultant Cardio vascular & Thoracic surgeon Vikram Hospital,Bengaluru said,"The best feature about ECMO is that it can be used at any age. Everyone,who needs it can benefit from the procedure. In case of patients who havechances of reversibility of heart-lung function, it reduces the stress on theseorgans. Conversely, it won't be of use to those suffering from irreversibleheart damage. Also, those awaiting a heart transplant can be put on ECMO tillthey get a donor." 

VikramHospital offers telephonic and Whatsapp consultation, transport of ventilatedpatients to Vikram Hospital (Retrieval), transport ECMO – Team to visit to thereferral center, setup ECMO and retrieve the patient, update to referral centerregarding patient progress, long term follow up and post ICU clinics – forrehabilitation and counselling. 


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