Apollo ECMO Unit
The inception of the Apollo ECMO unit took place approximately in 2013, led by Dr. Sangeeta Reddy, Joint Managing Director of Apollo Hospitals, and Dr. Hari Prasad, President of Apollo Hospitals.
The Apollo ECMO Program is officially registered with ELSO (Extracorporeal Life Support Organization) and the ECMO Society of India.
The program offers comprehensive guidelines, protocols, and pathways for ECPR (Extracorporeal Cardiopulmonary Resuscitation) and ECMO treatment.
Apollo Hospitals is at the forefront of ECMO technology, providing exceptional care with a total of eight advanced machines. Our ECMO inventory includes one Cardio help machine, renowned for its capabilities, along with four Rota flow machines and three Delta stream. Medes machines, all of which contribute to our commitment to delivering high-quality ECMO therapy.
We understand that this is a stressful time, and it’s normal if you don’t remember everything we explain. Don’t hesitate to ask us the same question again. We’re here to help!
Let’s introduce you to the key members of our team:
- Attending Physician: This is the lead doctor overseeing your family member’s care. Our physicians are renowned worldwide for their ECMO research and advancements.
- ECMO Fellow: This surgeon specializes in treating severe respiratory failure and manages patients requiring ECMO. They work closely with the attending physician.
- ECMO Specialists: Specially trained nurses and respiratory therapists who handle the ECMO equipment and closely monitor ECMO patients on a minute-to-minute basis.
- Critical Care Nurses: These nurses provide care and comfort to your loved one. They are your go-to source for information and can answer many of your questions.
- Respiratory Therapists: These professionals are experts in managing ventilators and provide recommendations to the rest of the team. They also assist with various procedures.
- Resident Physicians: These medical doctors are undergoing specialized training in surgery. They provide around-the-clock bedside care, under the guidance of the attending physician and ECMO fellow.
- Social Worker: The social worker can assist you with accommodations, financial concerns like insurance and parking, and help you cope with the emotional challenges of a life-threatening illness.
- Clinical Care Coordinator: This nurse serves as a resource during and after your hospital stay. They can address any questions or concerns about the care plan, prepare you for discharge, and provide follow-up support.
Remember, our entire team is dedicated to supporting you and your family throughout this journey.
Apollo Hospitals has achieved significant milestones in ECMO care. In 2013, we pioneered the first ECMO procedure, marking a groundbreaking advancement in critical care. Since then, we have successfully performed a total of 212 ECMOs, providing life-saving support to patients in need. With a recovery rate of 57%, our dedicated team has helped numerous individuals regain their health and return to their loved ones.
The average age of patients treated with ECMO is 46.5 years, and the average duration of an ECMO run is 13.65 days. With multiple initiation sites available, we ensure timely and effective ECMO interventions for those who require them. These achievements have garnered recognition for Apollo Hospitals, establishing us as a leading institution in ECMO care.
Let’s take a look at where ECMO can be used and under what conditions:
Lung problems that may need use of ECMO
- Pneumonia, not manageable with ventilator
- Acute respiratory distress syndrome (ARDS), Lung Failure:
- Blockage in a pulmonary artery in the lungs (pulmonary embolism)
- Defect in the diaphragm (congenital diaphragmatic hernia)
- Flu (influenza), Pneumonia, Hantavirus pulmonary syndrome
- High blood pressure in the lungs (pulmonary hypertension)
- Trauma to chest wall and lungs
- High risk surgery on and around airways and lung
Heart problems that may need use of ECMO
- Heart attack (acute myocardial infarction)
- Heart muscle disease (decompensated cardiomyopathy)
- Inflammation of the heart muscle (myocarditis)
- Life-threatening response to infection (sepsis)
- Low body temperature (severe hypothermia)
Cardiac arrest may need ECMO (ECPR) if due to
- MI (myocardial infarction)
- Pulmonary embolism
- Refractory ventricular fibrillation
- Cardiac injury
- Drug intoxications
ECMO Facilities at Apollo
At Apollo, we pride ourselves on providing top-notch facilities for ECMO (Extra Corporeal Membrane Oxygenation) treatment.
- The ECMO unit is equipped with a dedicated team of trained experts and state-of-the-art facilities, providing advanced maintenance and management for patients 24/7.
- In the ER, specific beds are available for initiating ECMO treatment for patients who are unresponsive and haven’t responded to standard therapies.
- For accessibility, we have an ECMO outreach team that evaluates and initiates ECMO in remote locations. We also have a dedicated 24/7 transport team with road and air ambulances for safe ECMO patient transportation.
- To facilitate timely decisions, we offer a 24/7 second opinion hotline and teleconsultation service for assessing ECMO eligibility. Our experts are also available to provide ongoing support and opinions for ECMO cases nationwide, ensuring continuous care.
- Our comprehensive ECMO program includes a 24/7 backup for catheterization lab and cardiothoracic surgery procedures. Additionally, we have an in-house heart and lung transplant team to support the ECMO program.
- Recognizing the importance of involving and supporting patient families, a patient family program is in place to provide guidance and assistance throughout the ECMO journey.
- Our dedicated team is equipped to initiate and transport ECMO patients from remote locations.
- We have extensive experience in air ambulance transfers for critically ill patients.
- Our team has successfully handled over 150 cases, achieving a 50% success rate.
- We are pioneers in providing ECMO support for COVID cases in India.
- Our expertise has been recognized by ELSO, an international society that oversees ECMO centers worldwide.
ECMO (ExtraCorporeal Membrane Oxygenation), offers a ray of hope to individuals whose hearts or lungs are struggling, even after exhausting all other treatment options.
This remarkable technology utilizes a sophisticated artificial heart-lung machine. In essence, the ECMO equipment serves as a replacement heart, pumping blood, and as substitute lungs, supplying much-needed oxygen.
By assuming the workload of these vital organs, ECMO allows them to recuperate and regain strength, providing a pathway to healing.
ECMO is a special treatment for children and adults who have serious heart or lung problems that haven’t improved with standard treatments like ventilators, medications, or extra oxygen.
It’s often used for conditions like:
- respiratory failure from trauma or infections,
- and cardiac failure.
ECMO doesn’t cure these conditions, but it provides support and gives the lungs or heart a chance to heal. Our hope is that this treatment will help your loved one recover and increase their chances of survival.
ECMO is a treatment that supports the heart and lungs by taking over their function temporarily.
It involves pumping blood out of the body, adding oxygen to it, removing carbon dioxide, and then returning it back to the patient. This process allows the heart and lungs to rest and recover.
There are two types of ECMO: venoarterial (V-A) and venovenous (V-V). V-A ECMO is used when there are problems with blood pressure or heart function. It involves placing catheters in both a vein and an artery to provide support for both the heart and lungs.
On the other hand, V-V ECMO uses catheters to allow blood to travel from one vein to another. This method doesn’t require tying off the carotid artery like in V-A ECMO. Sometimes, patients may start with V-V ECMO and later transition to V-A ECMO.
During ECMO, a large catheter drains blood to a pump. The blood is dark because it has very little oxygen. The pump maintains a steady flow rate of blood through the ECMO machine, where oxygen is added and carbon dioxide is removed in a membrane lung. The size of the lung depends on the patient’s size, and sometimes two lungs are needed for adults.
The blood is then warmed before being returned to the body, and it appears bright red because it now contains oxygen. You may notice other tubing and ports for blood withdrawal and drug administration, as well as safety features such as a pump regulator or “bladder box” and a backup power supply.
ECMO is used until the heart or lungs recover or until treatment is no longer effective, which can take days or weeks. The duration of ECMO varies based on the child’s age, original diagnosis, and individual factors. Newborns typically require ECMO for an average of 5-7 days, but it can extend to 14 days or more. Older babies and children may need ECMO for an average of 10-30 days.
Factors influencing the length of ECMO treatment include:
- the type and severity of lung or heart disease,
- pre-existing lung damage,
- and any complications that arise during ECMO.
When someone needs ECMO, it means they are really sick and could die without it. But there are dangers involved in this treatment.
The doctor in charge of ECMO will talk to you about these risks:
- Bleeding: To stop the blood from clotting inside the ECMO machine, a medicine called Heparin is used. The amount of Heparin given is watched carefully, but sometimes bleeding can still happen. Bleeding can occur in different parts of the body, but it’s especially dangerous if it happens around the brain. This could cause long-term damage to the brain.
If the bleeding becomes severe, one or more of the following measures might be required:
- Frequent transfusions of blood
- Additional surgeries to manage the bleeding
- Stopping the ECMO treatment
- Blood Clots: Small clots in the bloodstream can harm vital organs like the brain or kidneys.
- ECMO Equipment Malfunction: Though rare, the ECMO system’s equipment can fail, but there’s a specialist available around the clock to respond quickly.
- Stroke: Bleeding or blood clots in the brain can lead to a stroke. In some cases, a surgical procedure involves tying off one carotid artery.
- Other Complications: Connecting the ECMO machine may result in infection, bleeding, or vocal cord injury. Heart or lung function may not improve, and severe bloodstream infections can damage vital organs.
- Blood Transfusion: Very rarely, serious reactions like shock or kidney failure can occur. There’s a slight risk of acquiring infectious diseases, although improved donor screening and blood testing reduce such risks.
- Once the physician determines that your child is eligible for ECMO and you give consent, the ECMO physician takes charge of your child’s care. Other specialists like cardiologists, radiologists, pediatric surgeons, or neurologists may also be involved in their treatment.
- – ECMO Specialists, specially trained nurses or perfusionists with ICU experience, play a crucial role in your child’s daily care, managing both the patient and the ECMO equipment.
- There are additional support resources available for you and your family. If you need help with practical matters like housing or emotional support for coping with your child’s illness, ask your child’s nurse to connect you with the social worker.
- A chaplain is available round the clock. Furthermore, former ECMO parents who have gone through similar experiences are ready to provide support and understanding.
During ECMO, all the necessary nutrition for your child’s energy and growth will be delivered through intravenous (IV) therapy. If you’re currently breastfeeding or planning to breastfeed, it’s recommended to discuss it with your child’s nurse or doctor. In many cases, breastfeeding can be initiated once the baby is no longer on ECMO. In the meantime, you can pump your breasts and store the milk. Feel free to ask your baby’s nurse for guidance on pumping and storing breast milk.
ECMO Comfort Measures: Pain Control and Enhanced Comfort
During ECMO catheter insertion, your child receives numbing medicine and pain medication, although pain is typically minimal. We provide cushioning, such as sheepskin or egg crate mattresses, to prevent pressure areas on the skin. Eye shading, pacifiers, booties, and specialized beds are used for comfort. Regular diaper changes, bathing, and repositioning are also part of our efforts to ensure your child’s comfort during ECMO.
Visitation guidelines for patients receiving ECMO care are as follows:
- As a parent or family member, your presence is vital to the care and recovery of your loved one on ECMO. Visitation policies vary by unit, so please consult the nursing staff for specific guidelines.
- If you require overnight accommodations, our social worker can assist you. You can actively participate in your child’s care by providing special items, offering comforting touch and voice, recording stories or songs, and involving siblings through drawings.
- Some units allow sibling visits—ask the nurse for details. Keeping a journal of your child’s progress can help you understand their condition and communicate effectively with doctors.
- Taking care of yourself, eating properly, and getting rest are crucial too. You can always call us for updates when you’re away from the bedside. We’re here for you.
- The ECMO procedure begins with the placement of catheters into the blood vessels by a surgical team at the bedside.
- Pain control and sedation medications are administered to ensure comfort. Once connected to the ECMO system, the ventilator is adjusted to low settings, allowing the lungs to rest.
- Pain medication is regularly given, and efforts are made to keep your loved one alert and awake, although some patients may require heavy sedation. Special beds are used, rotating to relieve pressure on the skin and aid lung secretions.
- Daily routines involve chest X-rays, blood tests, and suctioning of the lungs. Nutrition is provided through specially formulated solutions administered intravenously or through a stomach tube.
- As the heart and lungs improve, ECMO support is gradually reduced, leading to a trial of ECMO.
- If successful, ECMO is discontinued, and the patient may still require ventilator support until further progress is achieved.