How ECMO saved man whose heart stopped pumping and organs failed

In the third week of March, Girish was returning with his wife from their regular morning walk from a temple. After walking for 4.5 km, he suddenly experienced a loss of consciousness and dizziness. The Mulund resident was immediately rushed to the nearby Fortis Hospital when his heart was functioning at 5 per cent of its strength.

The coronary angiography showed all blood vessels to his heart were blocked. The clinical condition continued to worsen with his oxygen requirement up to 100 per cent, and blood pressure support medicines shooting up by the minute. He needed urgent procedures, first to stabilise, and then to open all the blockages.

An intra-aortic balloon pump (IABP) — a therapeutic device that helps the heart pump more blood — was inserted. It would improve the coronary blood supply and decrease the heart’s workload. Next, he was shifted within the hour to perform an emergency CABG surgery. But all in vain. After the surgery, where 8 grafts were put in to supply blood to the heart, it was found that the heart muscle was stunned and not contracting. Meanwhile, his kidney and liver had already started failing. His body needed to be supported till his heart would normally beat again.

At that time, his only chance of staying alive was the ECMO device. Surgeons would place two catheters in his heart. One catheter would siphon the blood out of his body, and run it through a machine next to the bed that would add oxygen and remove carbon dioxide before returning the blood to his body through the other catheter. This machine takes the heart and lungs out of the equation entirely. It is similar to a dialysis machine.

Patients like Girish, who would have died, are given a second chance at life with ECMO. “ECMO not only kept him alive while his heart did nothing but also helped his vital organs like liver and kidneys recover. His blood pressure and oxygen had dropped due to his unsupported failing heart before the surgery, pushing him into multiorgan dysfunction. After 48 hours, the heart started beating, and after four days, the liver functions and urine output improved along with cardiac pulsatility,” said Dr Jumana Haji, director of the ECMO programme at Fortis Hospital.

Girish appeared relatively stable but was on a razor edge. When doctors tried to safely get him off his surrogate heart and enable his native heart to fully start supporting his body functions — fluid accumulated around his heart.

However, within two weeks, his heart’s function improved from 15 per cent to 35 per cent and all other organ dysfunction was reversed. “With the support of ECMO, he moved from being a dying, heavily sedated man in all organ failure to one who was sitting on the edge of the bed talking to his family and writing down his needs,” said Dr Haji.

ECMO has been used for decades for lung and heart failure but it gained public attention amid the pandemic as the last-ditch intervention for the sickest patients with Covid-19. Dr Haji outlined the need to rush patients with heart attacks to hospitals which have this device — it can provide the required bridge for the recovery of the heart before planning for surgery or even a heart transplant.

“The golden hour period of four hours is essential. In this case, if we didn’t have the ECMO machine, we would have to refer him to another centre with the facility, risking his life,” she added.

However, this life-saving treatment does come with a price tag. Keeping the patient alive on ECMO costs around Rs 1 lakh daily.

Many sickest-of-sick patients on the long waiting list for heart or lung transplants are also kept on ECMO to give them additional time. “Patients on ECMO are always prioritised more for organ transplantations due to their deteriorating health condition,” she said.

Girish is currently at home and living a normal life with 30 per cent heart pumping but has to follow a strict lifestyle and control his daily water intake.