How Apollo Hospitals saved 17 lives using ECMO during second wave of COVID

Suneeta Reddy, managing director of Apollo Hospitals | Aayush Goel Suneeta Reddy, managing director of Apollo Hospitals | Aayush Goel

How far can a machine go to save lives? Can it save a Covid-19 patient whose lungs are severely infected? Can it act as an artificial heart when the real one is close to collapsing? For a multidisciplinary team of doctors at Apollo Hospitals, the answer is yes. During the pandemic, they used Extracorporeal Membrane Oxygenation (ECMO) therapy to save several critically ill patients. “For patients who cannot be saved when on ventilator, ECMO is a lifesaver,” said Suneeta Reddy, managing director of Apollo Hospitals.

During the pandemic, Apollo had brought together a 143-member ECMO team that had cardiothoracic surgeons, pulmonologists, perfusionists, nutritionists, technicians and nurses.

Since 2010, Apollo has used ECMO to treat 270 patients. Before the pandemic, it was used in a variety of situations, including to treat poisoning, trauma, infections such as H1N1, and to stabilise pre- and post-transplant patients.

What is ECMO?

The ECMO machine is like a heart-lung bypass system. The patient’s blood is collected into the external machine through tubes placed inside large veins (close to the heart). It is then purified, oxygenated and pumped back into the body. It lessens the load on the lungs and the heart.

The majority of Covid-19 patients have respiratory problems and only lung support is required. In a smaller number of patients, the heart, too, needs help.

At Apollo, the multi-disciplinary team used ECMO to save 17 patients during the second wave of the pandemic. “If given enough time, the lungs can recover in a majority of Covid-19 patients,” Paul Ramesh, senior consultant, cardiothoracic and heart and lung transplant surgeon, Apollo Hospitals, told THE WEEK. Of the 17, there was a 28-year-old patient from Gujarat who was on ECMO for 116 days. He recovered fully. Apollo had placed 23 patients on ECMO during the second wave; of the lot, 10 were discharged, one had a successful transplant and two are off ECMO and currently undergoing rehabilitation. Four are still on ECMO. “The average period on ECMO prior to discharge is 60 days,” said Ramesh. “The current survival rate at six months for ECMO patients is 73.9 per cent [at Apollo], which is higher than the global average of 40 to 50 per cent.”

Said Dr K. Madhankumar, senior consultant, cardiothoracic and heart and lung transplant surgeon, Apollo Hospitals: “The reasons for our team’s success include awake ECMO, which allows patients to remain awake and engage with their families, which boosts their morale and enhances the likelihood of faster recovery and better treatment outcomes. Patients on ECMO are urged to exercise on a regular basis, and physiotherapy is provided to fully mobilise them quickly after they have been [taken off] the machine.”