Wednesday, January 20, 2021

In a first in India, doctors airlift COVID sequela patient on ECMO from Nepal; save life

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Setting new benchmarks in saving lives, doctors at Max Super Speciality Hospital, Saket helped transfer a 37-year-old critically ill Covid pneumonia patient on ECMO machine from Nepal. The patient, Abhishek Kumar Agarwal, was plummeting rapidly despite 100% ventilator support due to COVID pneumonia with extensive Lung involvement (ARDS). He was put on a ventilator in a hospital in Nepal but continued to be sick. He was given timely help by a team of Max doctors who specially flew down to Kathmandu and put him on immediate VV ECMO support. 

ECMO or Extracorporeal Membrane Oxygenation is a life support machine replacing heart and/or lung functions. The machine pumps blood from the patient’s body to an artificial lung (oxygenator) that adds oxygen to it and removes carbon dioxide. Elaborating on the condition of the patient, Dr. Kewal Krishan, Director, Heart Transplant & Ventricular Assist Devices, Department of Cardiovascular Surgery, Max Hospital, Saket said, “The patient from Uttarakhand was in Katmandu, Nepal for a business trip. He had been complaining of fever for over a month and was initially treated at home. After 3-4 days, however, he developed difficulty in breathing and was diagnosed with COVID-19. He was admitted in a hospital in Kathmandu, but his oxygen saturation levels kept dropping despite mechanical ventilation. That’s when we were contacted by the patient’s family and flew down to Kathmandu and put him on VV ECMO support.” 

The patient was admitted in the Cardiothoracic Intensive Care Unit (CTVS ICU) in an intubated state, on ECMO and also started on I/V antibiotics. Radiology images showed that the left lung pneumothorax which meant that it was close to collapsing. A left sided chest tube was inserted to help drainage and antibiotics modified accordingly.  

Dr. Vivek Nangia, Principal Director & Chief of Pulmonology (Cluster 1), Max Super Speciality Hospital, Saket said, “Patient had extensive pneumonia in both the lungs despite being on ventilator with 100% support, that’s when we decided to put him on ECMO. ECMO is a procedure which has been well established in the western world but still in a nascent stage in our country. We are privileged that this facility is available with us. With this we can save the lives of people who are on ventilator and not improving. One of its major advantages is that it acts as an artificial lung outside the body and protects the patient from ventilator related complications.”  

While an ECMO machine can help save a person’s life, it does not treat the disease or injury that leads to the heart or lung failure. The machine can only provide support for a person while the healthcare team works on treating the underlying disease. It was only due to the quick thinking of the Max team of doctors and the right treatment protocol adopted to treat the worsening condition of the patient that the patient was stabilised within 18 days of his admission in Max. Some people, however, are not able to improve enough to be taken off the ECMO machine where it can help improve survival for critically ill patients responding to usual life support options. 

Dr Krishan added, “I am happy to report that out treatment modalities not just helped get the patient off ECMO quickly but also helped him get back on the road of recovery in a short span. When we had initially gone to get the patient, we were not very sure about his chance at recovery, yet we kept a strict vigil on his symptoms and vitals and our team of doctors helped tide over the deteriorating condition of the patient helping him stabilise and recover in record time.”  

The patient’s family too is deeply grateful to the Max team and look forward to the patient getting back to his routine very soon. With the first of its kind airlifting of a patient on ECMO support transcending international borders, Max team has set the precedence for more such treatment being possible for patients living in remote areas and not having access to the right kind of medical infrastructure for saving their lives.  

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