Former Tamil Nadu Chief Minister J. Jayalalithaa’s death following cardiac arrest has drawn interest and raised awareness about Extracorporeal Membrane Oxygenation (ECMO), an advanced life-support device that she was put on to save her.
Private hospitals in the city with the facility claim getting frequent enquiries in the life-support device over the last two days, after the measures taken for saving Jayalalithaa’s life became publicly known. Doctors say ECMO is not routinely used; instead a specific set of indications and affordability determines if a patient can be put on it.
“It is not routinely prescribed but is used only after all other options to save life have been exhausted. When either heart, lungs or heart and lung are not able to function, the device is used. It is, however not used following brain surgeries,” said Nanda Kishore, an Intensive Care specialist at KIMS Hospitals.
India’s interest in the ECMO has evidently manifested itself on the internet. Google searches for information about the device spiked on December 5.
The machine extracts blood from the body through pipes placed closed to the heart and oxygenates it. Oxygen-rich blood is then pumped into the body. When the heart is not functioning, the oxygen-rich blood is pumped into the arterial circulation system; it is simply supplied to the heart when only the lungs have to be supported. Antibiotics are administered to keep infections at bay while sedation is usually maintained until the patient settles on the machine. There have been instances of patients in the west put on ECMO for over 200 days, informed Dr. Kishore.
Swine flu
Infectious conditions of the heart, heart malfunction following heart surgeries, heart failure and acute viral infections that overwhelm the lung like swine flu, are some of the indications for using ECMO.
“ECMO gives the treating physician time to improve treatment modalities. It has its pros and cons, which are weighed before putting someone on the device. The initial condition, patient recovery and affordability help determine who can be put on ECMO,” said Praveen K. Nandagiri, of Century Super-speciality Hospital.
According to Dr. Nandagiri, ECMO can cost a patient around Rs. 12 lakh for 15 days.
“The oxygenator which enriches the blood can be used for 30 days but all components are disposable. Efforts are being made to lower the cost of ECMO treatment in the country,” he said.
Given the high cost of treatment involved, the ECMO is restricted to private hospitals though government hospitals including Gandhi and Osmania General Hospital have state-of-art heart lung machines which are similar to ECMO but are less sophisticated and mainly used for the duration of surgeries.
-Rohit P.S.