Hyderabad: Extra-Corporeal Membrane Oxygenation (ECMO) is an extra corporeal life support system which supports the heart and lung. It is also called the heart and lung machine. It is mostly used in patients whose heart is weak or a few days before heart transplant when they are waiting for a donor heart. It is also widely used for the recovery of lung in extreme cases of swine flu, respiratory and viral infections and also in cases where the patients develop severe breathing problems and have to be given extra life support. The machine allows for oxygen to flow and removes carbon dioxide from the blood. It is used in high risk patients.
Steps taken to revive heart after cardiac arrest
In a cardiac arrest the first thing done is to massage the patient’s heart so that the blood supply to the brain is not stopped otherwise it would result in damage to the brain. The patient is put on ventilator support. Massage to the heart is to be done for 45 minutes according to the protocol as patients have revived even after 45 minutes. Drugs are supported and electric shocks are also given. This ensures that the blood supply to the brain is not stopped and it is functioning.
Inputs by Dr A G Gokhale, senior heart transplant surgeon at Apollo Hospitals and Dr Kishore Jayanthi, ECMO specialist and paediatrician at Star Hospitals
There are 2 main types of ECMOs
- VA or Venous-Arterial ECMO in patients with both respiratory and cardiac compromise, and V-V ECMO in patients with respiratory failure whose lung function is compromised.
- The effectiveness of ECMO depends on the age of the patient and also the damage to both the organs heart and lung. If both are on the system, then medical journals have recorded a less than 40 per cent chance of survival.
- Depending on the weight of the patient, the blood is circulated from the machine.
- A monitor checks the pumping of the heart every minute and in case the blood pressure is falling an alarm sets off calling the emergency team to handle the patient.
- Patients can be kept on the machine for four to six weeks but the recovery of the patient is evaluated in the first five days only. If the heart does not recover, then it becomes important to wean off the machine.
- The use of machine for more than 10 days results into foreign body infection, paralytic attack, stroke and also other complications.
- While the heart and lungs are working on this machine, the kidneys have to be on dialysis & also the liver has to be kept functioning.
- The machine has to be installed in 40 minutes after cardiac arrest. Installing takes 30 minutes and till that time the patient has to be on Cardio Pulmonary Resuscitation including chest compressions, massaging of the chest and electric shock to revive it. The machine costs Rs 4 lakh per patient as installing charges and Rs 40,000 is the daily maintenance charge.
