DEDICATED ECMO UNITS: A POST-COVID IMPERATIVE

In the post-Covid world, the necessity of dedicated ECMO units have become paramount for managing critical cases efficiently, says the author.

- Dr Jumana Haji

Extracorporeal Membrane Oxygenator (ECMO) is a surrogate lung or heart that can be used in patients who suffer from heart or lung failure. The first reported adult ECMO case was in the year 1972, and first neonate ECMO case in 1975. This technology was used in children with heart disease or lung failure for many years in the western countries.

It was accepted as a treatment modality for adult patients after the 2003 Swine Flu pandemic, and its use became more global with more Asia Pacific countries utilizing ECMO for severe viral lung failure. In India, the use of ECMO was limited to cardiac surgery patients, and it was largely unknown as a life-saving option to the general population.

During the COVID10 pandemic, as the lung failures were severe and ventilators were not able to achieve gas exchange, ECMO emerged as a sought-after treatment modality. However, as the technology was new to India, the number of providers with expertise as well as number of hospitals with the infrastructure and equipment were limited.

ECMO ADOPTION PREREQUISITES 

ECMO is costly, resource intensive, and needs skilled manpower. ECMO needs a multidisciplinary team effort, advanced diagnostics, trained nursing, special equipment and specifically designed ICU cubicles. 

This infrastructure is usually present in cardiac and transplant centers. Patients admitted under adult or pediatric critical care, for both—cardiac surgery and/or for medical management of shock or respiratory failure—may benefit from ECMO.