OVERVIEW OF THE CASES HANDLED BY THE ECMO TEAM
(DIVISION OF EXTRA CORPOREAL LIFE SUPPORT, DEPARTMENT OF CRITICAL CARE MEDICINE, FMRI GURGAON):
Since the program took off in December 2014 when we successfully treated a patient of resistant septic shock with ECMO, we have used the modality in 25 patients with varying diagnosis.
Veno Arterial (VA) ECMO
This form of ECMO has been instituted in 3 cases of Aluminium Phosphide poisoning, a cardiotoxic poison with successful result in 2 of them. One of the survivor was put on ECMO during ongoing CPR (E-CPR).
VA ECMO has also been used in cases of Myocardial infarction, Septic shock with myocardial dysfunction, with results comparable to international centers.
In India, the need for rapid and effective management of poisonings is an essential requirement at all levels. Toxicology has always been handicapped by the absence of effective antidotes leading to high mortality in some poisons like Aluminium Phosphide (Celphos) which is cheap and easily available as rat poison but has a mortality approaching 99%. This modality has generated interest in these cases as now we feel that this mortality can be reduced greatly. Moreover we hope that
E-CPR was done in two young patient including the one mentioned above.
This form of Extra Corporeal Life Support (ECLS) is becoming essentially important in the current medical scenario but India is seriously lagging behind. This has even become part of the new Advanced Cardiac Life Support (ACLS) Guidelines 2015 by American Heart Association (AHA). This area will be our major area of interest over time to try and save young lives.
Veno Venous (VV) ECMO
This form of ECMO has been instituted in a much wider array of cases.
Primary Acute Respiratory Distress Syndrome (ARDS) like in Viral Pneumonia (eg H1N1) , Acute Interstitial Pneumonia (AIP), Alveolar Hemorrhage, MRSA Pneumonia, , Transfusion Related Acute Lung Injury (TRALI) and Secondary ARDS like Severe Acute Pancreatitis, Acute Liver failure and auto immune disorders; with encouraging results, comparable to international standards.
ARDS is a formidable adversary for intensivists worldwide. With protocolisation of ventilator and ICU care, mortality due to this syndrome declined worldwide but still remains a major cause of death due to respiratory causes. The modality of ECMO gives us hope of further bringing down the mortality rate especially in resistant cases when earlier giving up hope was the only way ahead.
We will regularly update this segment about the fresh cases and challenges we face.