ECMO no silver bullet, very risky, aggressive use not good: Experts
New Delhi: Medical experts in Delhi are divided on the use of ECMO (Extracorporeal Membrane Oxygenation) machines as there is a sharp rise in the number of post-Covid complications and infections.
ECMO (Extracorporeal Membrane Oxygenation) machines are expensive and not easily available in hospitals across Delhi-NCR. Speaking about whether ECMO machine is a viable option for a critical patient, Dr. Shuchin Bajaj, Founder and Director at Ujala Cygnus Hospital said, "We need not be foolish about ECMO in Covid, because selection is very critical. Those who are late into the disease are less likely to survive. Doctors are saying ECMO is the only way because the patient is not responding to ventilator; unfortunately they have the least chance of survival. Those who fail to oxygenate on ventilator are not ECMO candidates. All the calls we are getting for ECMO, less than 10 per cent is worth trying for. And let's say if 10 people are selected for ECMO only four are surviving. Our condition only should be whether the patient will come out, because a patient cannot be on lifelong ECMO."
As patients are being recommended the use of ECMO, a chaos like situation has developed due to the lack of availability of ECMO machines in Delhi. Hospitals like Ganga Ram, Max and Apollo have the availability of ECMO, most of which are already occupied. For Rahul Sharma, whose family member is in critical situation and in dire need of ECMO, finding one has been a task. "He has been on ventilator, while the doctor has asked to arrange for ECMO, because the hospital he is at does not have the facility. There is also a lot of confusion as to whether ECMO is a viable option because doctors are saying different things about it."
Dr. Bajaj meanwhile emphasised that ECMO is not a "magic pill" and "we should caution against the over aggression of its use".
According to a source at AIIMS, ECMO's success rate for a patient is hardly anything. "If I talk about AIIMS, hardly 10 per cent patients have made it out alive, if they were sent on ECMO. It is a desperate situation, however use of ECMO is not helping the patients in most cases," he said.
ECMO requires a proper team where the patient is required continuous monitoring. According to Dr. TS Kler, Chairman at Fortis Heart and Vascular Institute, "People who are going on ventilator, I would say there is about 70 to 80 percent mortality in them, but whoever are going on ECMO about 98 percent are dying and the reason behind it is that we are putting people late on ECMO. On the other hand, a proper team is required to handle the machine, because there is constant monitoring of the patient, it is not a simple thing. No doubt we need more ECMOs, but we also need more manpower to handle it."
