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ECMO support is a light of hope for Covid-19 patients with severe lung injury

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Extracorporeal Membrane Oxygenation (ECMO) support is currently available in some hospitals to help patients with severe COVID with acute pneumonia or lung damage and when the ventilator is unable to maintain blood oxygen levels. It is being used. Support techniques traditionally used by cardiologists in the case of post-cardiopulmonary bypass or as a final-stage support mechanism for people in the path of cardiac and / or lung failure are now new to many COVID patients. Gives a life.

What is ECMO?

Dr. Suresh Rao, co-director of cardiopulmonary transplantation at MGM Chennai, told News18.com that ECMO support is essentially an extracorporeal membrane oxygenator for the patient. This is not a treatment for the lungs, but merely a support system / technology for performing lung functions so that the injured lung can rest and heal. Therefore, it is often referred to as the “bridge to recovery.”

“In COVID, the main organ affected is the lungs, and the function of the lungs is to remove carbon dioxide and take up oxygen. Then, the oxygenated blood is carried to all other organs. When the lungs become dysfunctional, there is no oxygen support for all organs and carbon dioxide accumulates in the body. In these situations, use extracorporeal membrane-type artificial lung (ECMO) support. ” Rao says.

“Usually, when the lungs fail, oxygen saturation in the blood decreases. In these situations, first administer oxygen with a mask, but after oxygenating with a mask, the saturation is still high. If low is observed, give a high flow of nasal oxygen. If the oxygen saturation rises or is not stable even after a high flow of nasal oxygen, a non-invasive artificial respirator such as a BiPAP machine ( Place the patient in NIV). If that also fails, connect an oxygen pipe to the patient’s trachea and attach it to an invasive artificial respirator. After all, the saturation is very low and the patient’s condition. If is constantly getting worse and you could lose your patient if you do nothing, you will get ECMO support, “he added.

How does ECMO help severely ill COVID-19 patients?

Dr. Subhash Chandra, Chairman of the Heart Disease BLK-Max Super Specialty Hospital, told News18.com: And / or in the case of hypercoagulation, such lungs need to be rested until the lungs have healed significantly (with medication and rest) in order to perform their own function without external support. Until that happens, we transfer lung function to the ECMO machine. ECMO machines oxygenate blood from the patient’s body and send it back to other organs, much like the lungs. Therefore, ECMO is a kind of auxiliary lung or extracorporeal lung, “he explained.

“In addition to the lungs, some COVID patients also have circulatory disorders, which means that the lungs are already in poor condition and arterial blood pressure is not supporting the body. In such cases, the patient has VV. (Venous) Requires VA ECMO (Extracorporeal Membrane Lung) instead of ECMO support. VA-ECMO support helps not only the lungs but also the patient’s circulation. Therefore, the patient is shocked. If you are in a condition and have difficulty breathing, you will be given VAECMO, and if the patient has only lung damage and blood pressure is maintained, you will be given VVECMO, “Dr. Chandra pointed out.

What are the side effects of ECMO, and is it affordable?

The negative effect of placing a patient on ECMO is that it can exaggerate coagulation. Therefore, patients need to be given many anticoagulants. “During the period of COVID, especially in severe cases, the patient’s immunity is already weak and is prone to various secondary infections. Therefore, if someone receives ECMO support, that person will always be monitored. We need to, “said Dr. Chandra.

“ECMO treatment is a dedicated program that runs in specialized hospitals and some large hospitals. ECMO treatment is also available in large government-run hospitals. The initial cost to use this technology is about 4 racks. And the daily cost to maintain this support is about 50,000, “he added.

“The longer a patient stays in ECMO, the more likely they are to have complications. The ELSO registry also shows that ECMO’s overall performance in critically ill covid patients is not very good. “The doctor said.

What if ECMO fails?

If the patient’s lungs do not heal in the long term, it is generally recommended that the patient undergo a lung transplant. Late, lung transplants are happening in India, especially in the southern states. However, it is a logistically expensive and rewarding process, and getting lungs is not easy.

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