ECMO (Extracorporeal membrane oxygenation) is a new methodology in India that has been brought as a treatment for pulmonary and cardiovascular patients and their ailments. This process provides additional support to the heart and lungs of patients when they are unable to provide an adequate amount of gas exchange or oxygenate the blood for the proper functioning of the body. This technique, when simplified, means to have bypass surgery both for the heart and lungs. It’s even similar to the core-lung bypass machine used for open-heart surgeries. This procedure helps oxygenate a patient’s blood outside the body, and it helps the heart and lungs to ease up and take appropriate rest. The methodology is simple when connected to an ECMO machine. First, the blood is passed through the machine, which then oxygenates the blood and removes the carbon dioxide. Finally, the blood is heated back to the body temperature to be pumped back into the body. This procedure needs a simple surgical insertion of tubes to inhale and exhale the carbon dioxide-filled air. This keeps the body running, and it’s same as an artificial heart.
Now one may have this question as to why ECMO and when it will be used on a patient. It is used when the patient has considerable lung damage and heart weakness. When the valves of the heart are weak, and there stands to be a high risk to the lung, then to be on a safer side, this might be used. This is also used as a support bridge when there is an independent assessment of other organs like the kidney and liver before a heart or brain surgery. This is done to check the health of these organs to prevent any complications and multi-organ failures. The ECMO methodology and machine are used in the cath lab while the heart undergoes complex valve replacement or transplant processes. As it serves both the lungs and the heart, so in case of a transplant process, this machine keeps the tissues and walls well-oxygenated to ease up the operation of the transplant.
ECMO in India has been widely used even for stroke patients and open heart surgical procedures. While being placed on an ECMO, one needs to undergo a minor surgical procedure. And it may be accompanied by a patient being put on a ventilator to let the lungs heal. The process has gained more importance, especially in India post the COVID-19 pandemic. Patients with lung ailments, especially fibrosis and pneumonia, were seen with heart problems requiring a procedure encompassing the heart and lungs. This has thus been used a lot to efficiently support patients and give them a second chance at life. ECMO has no problems or complications except for a minor case of clots and infection at tube insertion sites. For which the doctors keep the patient on sedatives and blood thinners along with antibiotics. According to many experts and doctors, this is a hybrid procedure between surgical pulmonology and cardiovascular surgeries. As in any surgery concerning the heart, lungs have to be kept safe and vice versa. Thus doctors trust this procedure to help decrease complications and help patients.
ECMO as a medical treatment has had an extensive and long history. It was invented in the late 1950s by John Gibbon and then by C. Walton Lillehei and since then, it has been continuously used. In the early days, it was used to provide support to patients going through cardiopulmonary bypass operations. In 1965, it was first used for neonates. And with time and evolving technology, in 1971, it was first used to treat a patient with acute respiratory failure by Dr. Solomon Hill. In India, it got a boost with the ECMO Society of India (ESOI) being established in 2010 with the ideals of improving awareness and practice of ECMO in India. In what seems to be an apparent miracle and success story of this procedure, a patient with COVID -19 induced lung infection and heart ailments recovered and came back disease-free after spending 109 days in the hospital. This tells the advancement this procedure has seen and how successful it can be for patients with complicated ailments.