Safdarjung giving ECMO therapy to COVID-19 patients

Safdarjung Hospital is the only government-run facility in Delhi to offer ECMO (Extracorporeal membrane oxygenation) as the last resort treatment for Covid-19 patients with severely damaged lungs. The treatment involves taking over the function of the lungs and the heart, allowing the isolated damaged lungs to heal. However, the two patients put on ECMO therapy at the hospital didn’t survive and the treatment itself is very expensive.

While ECMO treatment has been successful in patients with acute respiratory distress syndrome and is considered by some as the only hope for Covid-19 patients who won’t survive even with ventilator support, its success rate has been very low. Recently, a seriously-ill Covid patient was treated successfully using ECMO at the KIMS Health hospital in Kerala’s Thiruvananthapuram. Another Covid-19 patient, a doctor from a Delhi government hospital, has been on ECMO support for over 40 days at Yashoda hospital in Hyderabadad, awaiting a lung transplant.

The patients offered ECMO treatment at Safdarjung hospital were critical and died of other complications. The first one admitted last year died of a heart attack three days after being put on ECMO and the second patient, a woman under 40 years of age, admitted during the second Covid wave this year, died after 18 to 19 days of treatment due to sepsis or blood infection.

New Delhi’s All India Institute of Medical Sciences (AIIMS) also has ECMO treatment facility but the institute did not use it on Covid-19 patients due to chances of survival being very low. Dr Anjan Trikha from the premier institute says ECMO should be offered to a very narrow subset of people and that too in existing high-volume centres (where a lot of ECMO cases are handled). The cost of the treatment alone is likely to be a deterrent for many, she adds.

“There were people running from pillar to post to get ECMO treatment during the second wave. All patients’ relatives should be told about the approximate total cost of the therapy, the time duration it may be required, and the outcomes – both good and bad. The worst case scenario regarding the need of lung transplantation, its cost and outcome should also be discussed. There are success stories with use of ECMO, but it is not a wonder therapy. There have been instances when people have run out of money before their patients have been weaned off the ECMO. Further, when it is done, it must be done only in established, high volume centres,” said Dr Trikha.

The machine costs about R 35 lakhs and with the consumables used, the cost to the patient is about ₹1.5 to 3 lakhs a day, excluding the cost of highly trained manpower needed to deliver the therapy. The therapy must be used within a week or ten days of a patient going on a ventilator and the ideal candidate would be a young and healthy person with no or minimal involvement of other organ systems. Hindustan Times