ECMO Challenges and Its Future: Indian Scenario

Abstract

History of extracorporeal membrane oxygenation (ECMO) in India dates back to 2001. Initially, ECMO was started for postoperative cardiac cases, but from 2008, it was introduced to intensive critical care unit as a regular practice for refractory cardiogenic shock and acute respiratory distress syndrome. Gradually, the utility of ECMO keeps on increasing such as in poisoning, transplant unit, and even in tracheobronchial surgery. Some centers even started using ECMO for extracorporeal cardiopulmonary resuscitation, even though the data is insufficient. In academic field also, ECMO has had great progress in India with three books and numerous paper presentations by Indian authors, regular conferences, and continued medical education. There were lot of challenges in establishing ECMO in Indian scenario which were addressed successfully; a few challenges are still there which need to be addressed pre-emptively. The most common challenges of ECMO were awareness, cost, initiation at right time, outcome, nosocomial infections, and transport. Transport of critically ill patient, especially on ECMO, is risky and also involves lots of cost. To overcome this problem, flying squad was established in 2010 where the team goes to the hospital where the patient is and initiates and manages ECMO there itself. The future of ECMO in India is quite promising, not only with increasing number of cases and centers, but also in terms of cost-effectiveness and technology.