Over the past several weeks, as the second wave of Covid-19 has devastated India and patients have struggled because of an acute shortage of medical oxygen, ICU beds and medicines. To counter this, a clinical intervention technique known as ‘ECMO’ has been in the limelight.
In critically ill patients, when oxygen support fails, specialists may resort to mechanical ventilation to help maintain oxygenation. However, some patients are no longer able to respond to such intervention- their heart and lungs are too weak or diseased to carry out the exchange of gases needed for the patient to stay alive. In these extreme cases, doctors may choose to apply ECMO.
What is ECMO?
ECMO or Extracorporeal Membrane Oxygen acts as an artificial heart and a pair of artificial lungs outside the body (thus ‘extracorporeal’), which removes carbon dioxide from the patient’s blood and adds oxygen to it.
The ECMO machine works by inserting a plastic tube into a large vein and/or artery through the patient’s neck, chest, or groin. This tube allows the patient’s blood to flow into an oxygenator (artificial lung). The oxygenator adds oxygen and removes carbon dioxide from the blood before a pump sends this blood back into the patient through a different tube, at the same frequency and force as that of the patient’s heart.
How does it save patients?
ECMO takes the load off the right side of the heart, as it is essentially bypassed by the machine itself. It also helps increase the level of oxygen going into the lungs, decreases pulmonary vascular resistance and reduces the pressure it takes to push blood through the lungs. ECMO process supports patients’ bodies and allows them extra time to combat the virus.
This technique has also been shown to successfully reduce the chances of a cytokine storm — in which the patient’s immune system turns on itself — which can cause a severe inflammatory response and multiple organ failure. The average Covid-19 patient can stay on ECMO for 10-12 days.
Risks associated with ECMO
Patients on ECMO sometimes do not get enough blood flow to their kidneys. This can cause their kidneys to stop working, a condition known as acute renal failure.
Another key threat is infection. The tubes from the ECMO machine go from outside the patient’s body directly into their bloodstream. This makes the patient extremely vulnerable to germs entering the body.
When to administer ECMO?
The technology is typically used when all other forms of heart and lung support have failed for critically ill patients. It is completely upon the operating doctor to take a call on this.
Even though it is not available widely across the country, ECMO can easily be one of the single most critical clinical interventions combating the COVID-19 when used effectively and could reduce mortality rates.
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