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ECMO

ECMO — Extracorporeal Membrane Oxygenation

Advanced life support for patients with severe heart and lung failure

Overview

Extracorporeal Membrane Oxygenation (ECMO) is an advanced life support technique that temporarily takes over the function of the heart and/or lungs, allowing these organs to rest and heal. ECMO circulates blood outside the body through an artificial lung (oxygenator) that adds oxygen and removes carbon dioxide before returning the blood to the patient.

ECMO is used for patients with severe, potentially reversible heart or lung failure who have not responded to conventional treatments. It serves as a bridge to recovery, to more definitive therapies, or to heart/lung transplantation.

Dr. Nisarga and his team at KIMS Hospitals have extensive experience in providing ECMO support for critically ill patients, including those with severe cardiac failure, postcardiotomy shock, and respiratory failure.

Key Facts

Days to Weeks

Duration of ECMO Support

ICU-Based

Continuous Monitoring Required

Bridge

To Recovery or Transplant

Multidisciplinary

Specialized Team Required

Conditions Treated

ECMO — Extracorporeal Membrane Oxygenation is used to treat the following conditions

Postcardiotomy Cardiogenic Shock

Severe heart failure after cardiac surgery requiring circulatory support

Acute Myocardial Infarction with Shock

Massive heart attack causing profound heart failure

Acute Respiratory Distress Syndrome (ARDS)

Severe lung injury with profound oxygen failure

Severe Myocarditis

Inflammation of the heart muscle causing pump failure

Pulmonary Embolism with Shock

Massive blood clot in the lungs causing circulatory collapse

Bridge to Heart or Lung Transplantation

Supporting patients while awaiting organ transplantation

Septic Cardiomyopathy

Heart failure secondary to severe infection

Accidental Hypothermia with Cardiac Arrest

Rewarming and circulatory support after severe cold exposure

Symptoms

Patients with conditions requiring ECMO may experience one or more of the following symptoms. It is important to note that some conditions may be asymptomatic in their early stages.

Profound shortness of breath at rest
Severely low oxygen levels despite maximum respiratory support
Very low blood pressure not responding to medications
Reduced level of consciousness
Inadequate blood flow to vital organs (kidney, liver, brain)
Cardiac arrest refractory to standard resuscitation
Inability to wean from cardiopulmonary bypass after heart surgery

Important: These symptoms can also be caused by other medical conditions. If you experience any of these symptoms, please consult a qualified healthcare professional for an accurate diagnosis.

Diagnosis

A thorough diagnostic evaluation is essential for accurate diagnosis and treatment planning

ECMO is a therapeutic intervention initiated based on clinical criteria, not a diagnosis itself.
Echocardiography to assess cardiac function and exclude treatable causes
Arterial blood gas analysis to assess oxygenation and ventilation
Hemodynamic monitoring including cardiac output measurements
Lung imaging (chest X-ray, CT) for respiratory failure assessment
Multidisciplinary team evaluation to determine ECMO candidacy
Assessment of potential for recovery or candidacy for transplantation

Treatment Options

The choice of treatment depends on the specific condition, its severity, and individual patient factors

Conventional Medical Therapy

Medications and ventilator support for less severe cases

Veno-Arterial (VA) ECMO

Support for both heart and lung failure — most common in cardiac patients

Veno-Venous (VV) ECMO

Support for isolated severe lung failure

ECMO as Bridge to Recovery

Support until the heart or lungs recover function

ECMO as Bridge to Transplant

Support until a donor organ becomes available

ECMO as Bridge to Decision

Temporary support while evaluating long-term options

Surgical Approach

How the procedure is performed by Dr. Nisarga and his team

1

ECMO cannulation can be performed percutaneously (through the skin) or surgically (cut-down approach).

2

For VA ECMO: Cannulae are placed in a large vein (to drain blood) and a large artery (to return oxygenated blood).

3

For VV ECMO: Cannulae are placed in one or two large veins for drainage and return.

4

Cannulation sites include the femoral vessels (groin), internal jugular vein (neck), or directly into the heart for postcardiotomy patients.

5

The ECMO circuit includes a pump, oxygenator, heat exchanger, and monitoring systems.

6

Anticoagulation (blood thinners) is carefully managed to prevent clots while minimizing bleeding risk.

7

The ECMO circuit is continuously monitored by a dedicated perfusion team.

8

Wearing from ECMO is undertaken when organ function has sufficiently recovered.

Benefits

Why patients and physicians choose ECMO

Provides lifesaving support for patients who would otherwise not survive
Allows the heart and lungs to rest and recover
Maintains oxygen delivery to vital organs (brain, kidneys, liver)
Buys time for diagnosis and definitive treatment decisions
Can be initiated rapidly at the bedside in emergency situations
Serves as a bridge to recovery, transplant, or long-term device therapy
Enables complex cardiac repairs that require prolonged recovery time

Recovery & Rehabilitation

What to expect during the recovery period after ECMO

ECMO support duration varies from days to weeks depending on the underlying condition.
Patients are managed in the ICU by a specialized multidisciplinary ECMO team.
Continuous monitoring of anticoagulation, hemodynamics, and end-organ function is essential.
Once the heart or lungs show adequate recovery, wearing from ECMO is performed gradually.
After ECMO decannulation, the cannulation sites are repaired surgically or with manual compression.
Total hospital stay is prolonged — often weeks to months depending on the underlying illness.
Long-term recovery includes cardiac or pulmonary rehabilitation as indicated.
Psychological support is important — ECMO survivorship involves both physical and emotional recovery.

A Word from Dr. Nisarga

ECMO is a lifesupport technique, not a surgical procedure that would involve robotic or minimally invasive approaches. However, Dr. Nisarga's expertise in advanced cardiac surgery ensures that patients requiring ECMO receive comprehensive care including optimal surgical techniques for cannulation, management of complications, and timely transition to recovery or definitive surgical therapy.

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