ECMO Treatment Saves a Critial HIN1 ARDS Patient

ECMO Treatment Saves a Critial HIN1 ARDS Patient
Bangalore | Sep 20, 2010

A 57-year-old former government employee suffering from Acute Respiratory Distress Syndrome (ARDS), following HIN1 infection was successfully treated using Extra Corporeal Membrane Oxygenator (ECMO) system, infusing hope in critical H1N1 ARDS patients in the country.

"This is the first time the ECMO, which is an artificial heart and lung system, was used to treat a lung failure case following HIN1", Dr Binoy, consultant cardiac surgeon with Narayana Hrudayalaya, told media here today.

The cause of death most often in H1N1 cases was due to ARDS or lung failure. He said. In many cases apart from antiviroal antibiotic oselatamivir (Tamiflu), patients were put on ventilator support, which also sometimes failed to save the patient and the only hope in this acute deteriorating stage could now be the ECMO system.

ECMO is a complex system that serves as a heart and lung outside the body. The impure blood is taken out of the body and goes through the machine which purifies it. The oxygenated blood is returned to the body through a system of channels. "Connecting a patient suffering from ARDS to the EMCO, provides the diseased lung with rest required to clear the infection and help it regain its original function", he said.

Though ECMO has been used in cases of cardiac problems in the past, it is for the first time in the country, it was used for lung failure cases arising out of H1N1.

The patient Srinivas, earlier employed with KSRTC, had a bout of cough and cold for a week before he was admitted to a hospital where he was detected with H1N1. He was then put on Tamiflu and was in ICU for four days and had to be subsequently shifted on the ventilator for eight days.

"His condition deteriorated, and the hospital asked us to take my father home as there was no hope", his son said.

However, following a tip off that Narayana Hrudayalaya was trying out the ECMO method, the Narayana Hrudayalaya authorities were asked to chip in. Following which the EMCO was fitted on and he was shifted to Narayana Hrudayalaya.

"Managing the ECMO is the most challenging task as it has to be monitored 24x7. It required an organised effort of team experts including cardiac surgeon, pulmonologist, anaesthetist, critical care specialist, pefusion scientist, physiotherapist and nursing staff", Binoy said.

"The patient was maintained on ECMO for 15 days. His condition gradually improved and we could disconnect the machine. Now the patient has recovered well enough and is expected to be discharged today", said Binoy.

Post ECMO, the status of the patient was normal and he would have to take precautionary steps like any other normal pneumonia patient would have to. There were no long term implications of using the system, he said.

The hospital currently had around six ECMOs which were being used in cardiac patients. Around 100 cardiac patients in last eight years had been put on to ECMO.

This is the second ARDS H1N1 patient put on ECMO. The first patient was put on the machine for 40 days and weaned off. However, after weaning off, his lungs could not regain their normal functioning as they were very badly damaged.

Asked why it had taken nearly a year for the doctors to come up with this treatment, he said though the ECMO system was available, it required considerable expertise to manage it in case of HIN1. The ECMO treatment had been tried out in US and Australia as well where nearly 70 per cent of the patients with ARDS had survived.

He also said that earlier while the death rate was four percent in HIN1, now with virus having been mutated, the death rate was eight percent.

On cost of the treatment, he said that it was still being worked out. However, cost would not be hindering factor at the Narayana Hrudayalaya for those who could not afford it.

Meanwhile, the patient said that he was feeling well.


http://news.outlookindia.com/item.aspx?694124