ECMO beyond a bridge for lung transplant: Experience from tertiary care hospital in Western India

Introduction: COVID pandemic marked greater use of ECMO (Extra corporeal membrane oxygenation) in the form of rescue cardiopulmonary life support especially for patients awaiting lung transplant however we found it lifesaving in poisoning cases as well.

Methods: We conducted a retrospective study from January 2020 till Jan 2022 in critical care unit in a tertiary care hospital in western India to share our experience of this life saving modality.

Results: 31 patients were provided ECMO support over the past 2-year study period with 24 (70.83%) males and 7 (29.17%) females. The average stay on ECMO was 4.9 days. In 20 (64.52%) patients veno arterial (VA) circuit was used whereas in 9 (29.03%) veno venous circuit was employed. The highest number of cases was of poisoning 9 (29%) comprising of 8 celphos poisoning and 1 silver poisoning. COVID-19 related ARDS and post COVID pneumonia had 5 (16.1%) of cases. Dengue 4 (12.9%) and post operative 4 (12.9%) each consisting of 1 CABG, 1 past DVR and 2 other post operative cases. In terms of survival 8 (25.81%) had favorable outcome. The patients who could be revived by ECMO were mainly of celphos poisoning – 6 cases, followed by ARDS post Dengue – 1 case and 1 case of post viral myocarditis.

Conclusion: ECMO is now an essential arsenal not only for bridging patients for lung transplant but also as rescue in poisoning cases as seen in present study with excellent results in those refractories to conventional therapies.