ECMO at RVCC

Mumbai

ECMO at RVCC, Mumbai

RVCC and ECMO

Dear Doctor,

It is a privilege to introduce ourselves. We are a dedicated group of intensive and critical care specialists practising in the northern suburbs of Mumbai, Maharashtra. Our main areas of interest are management of cardiorespiratory emergencies. In parallel with this, due to our proficiency and expertise in critical care management, our intensive care experts are facing a large population of refractory ARDS by various etiologies (leptospirosis, dengue fever, malaria and swine flu etc:) especially in the monsoon period in Mumbai at Riddhi vinayak critical care and cardiac centre (RVCC) Malad, Virar

Over the last 10 years, we have practised and tried to perfect the state of the art medical and mechanical facilities for ventilation and perfusion available in India. All the tools are assist devices to support the native heart and lungs. But beyond a limit, the damage to in vivo organs cannot be helped by external assist. The rest of the body goes into rapid secondary collateral setback in absence of proper oxygenation and circulation. The nature of damage by any disease process to heart and / or lungs may be temporary or permanent. But there are a large percentage of transient acute decompensation of these organs (like ARDS and ADHF) even in what appears as irreversible damage. In such situations, they (native organs) can be restored back to effective functioning only and only if, they get complete rest. At this stage, shift of paradigm from assist therapy to timely replacement treatment appears as the only option in this bail out situation. After getting alarmed by the growing prevalence of heart failure population due to rising demographics and incidence of coronary artery disease, all options of support in end stage cardiac damage like re synchronization therapy, stem cell therapy and mechanical circulatory support was our areas of interest. One of the effective method is extra corporeal membrane oxygenation (ECMO) under the auspices of extracorporeal life support systems (ECLS).

Looking at the better outcome by ECMO therapy in acute decompensated heart failure (ADHF) and severe refractory respiratory cases by various etiologies, there was a whole hearted efforts from our entire staff of RVCC to make ECMO into a effective and useful tool for ultra critical management of cardiorespiratory insufficiency

Preface – Dr Venkat Goyal

A extra breath – and more…… perhaps holds the last straw of hope and life.

Many a times in the past, I had lost by millimeters in athletics competition due to lack of a pause for a breath in the penultimate rounds. There was never a second go. It was always a do or die situation.

The same dilemma persisted till late in my real life for my critically ill patients. There was no solution for sudden crash in severe cardio respiratory failures. Once all our commonly practiced tools, including human skills, medicines and machines (only assist mechanism to native organs) fails to support the ailing organ to minimum efficiency, there is a full stop to life in a matter of minutes.

I have witnessed endlessly such helplessness over and over again. We are far behind the western world in mechanical ventilatory / circulatory support in the science of replacement therapy for heart and lung refractoriness. They start from where we end.

Such is the power and glory of ECMO (Extracorporeal membrane oxygenation) under the auspices of ELSO (Extracorporeal life support organization). It started abroad, as early as early seventies in last century. The principle is similar to dialysis in kidney failure, except for much higher volumes of circulation. It is difficult and challenging, but life rewarding to the extending of playing GOD.

I had earlier believed that medical science can improve only the quality of life, as quantity is destiny driven. But ECMO seems to have convinced me to reconsider my beliefs and misunderstandings.

Preface – Dr Oza

I started this book with a proverb stating that “when we are dealing with a saving of human lives, we have to be master of it & any lacunae in acquiring that becomes a crime.”

ECMO (Extra corporeal membrane oxygenation): A novel technology The science of Extracorporeal life support system is older than three decades in western world with more than 50000 cases registered till date. In Indian scenario, there are only few isolated case reports of bail out post paediatrics cardiac surgery patients on ECMO. Our knowledge about this novel technology is limited & even worse, we know very little about the principles of its practice.

The ECMO is different from a cardiopulmonary bypass. Unlike a heartlung machine, which is for few hours & is being managed by perfusionist, here the ECMO system runs for days together & you require proper intensive care personnel to maintain it.

This book is a humble trial to introduce the basic principle & practice of this wonderful technology. The book is designed in three volume, out of which the first volume contains the practical aspect of ECMO. Rest of the two volumes will be on theory of respiratory and cardiac aspects of ECMO. We have tried our level best to cover most of the technical & medical aspect related to ECMO so that the learners don’t face much difficulties in executing ECMO.

I hope this book may prove useful to many of our comrades & help them to take right decisions at the crossroad, so that together we can save as many lives as possible or at least give a second chance to life.

Lastly I will like to thank the Almighty and my mother for her blessings & endless support for giving me courage and strength to comprehend this – state of the art – “ECMO”. In valediction, from alpha to omega, the more, I try to fathom into the deep seas of critical care, greater is the utility of ECMO, I find, to help me and my patients to achieve health and survival.

Finally thanks to my family & Mr Suraj in helping me to complete this book.

Readers suggestion in the further up gradation of book is highly appreciated.

SAMPLE Daily flow chart for maintaining

ECMO MONITORING OF MACHINE AND PATIENTS PARAMETERS

A Family Guide to Neonatal ECMO A Family Guide to Adult ECMO