The boy from Kedamangalam, Paravur in the state of Kerala is one of the few patients in India, who was put on ECMO (EXTRACORPOREAL MEMBRANE OXYGENATION ) for MIS-C. The condition severely affected the muscles of his heart. The muscles were inflamed and were completely unable to pump blood. His blood pressure was extremely low when he was brought to the Amrita Hospital, Kochi.
ECMO works very well in clinical scenarios. The use of ECMO for cardiopulmonary support for pediatric patients with MIS-C is feasible. It can be considered part of the treatment algorithm for patients with severe cardiopulmonary dysfunction.
Dr. Suma Balan, Professor, Department of Rheumatology (Specialist in Paediatric Rheumatology) says putting a very sick child with low blood pressure and poor heart on a ventilator needs a high degree of skill. In the case of Aaadhik, the child required special lines to be inserted into his veins, so that medicines to elevate his blood pressure could be safely administered without needing to prick him all the time. A line was also inserted in a peripheral artery to help monitor his blood pressure accurately. A bedside echocardiogram was also arranged due to the severity of the child’s illness. However, the multidisciplinary team realized that the child needed more medical attention and it was decided that an ECMO would help his recovery.
ECMO is a process that does the blood exchange (oxygenation of the blood and allowing this oxygenated blood to be transported across the body). It is the work that the heart-lung complex does. In ECMO blood is pumped outside of the patient’s body to a heart-lung machine, allowing the blood to bypass the heart and lungs.
Dr. Mahesh K, Clinical Professor, Centre for Aortic Diseases and Marfan Syndrome, Paediatric Cardiology says ECMO is not about adding on another machine. It requires special lines to be attached from the patient to the machine and back, and a lot of specific precautions to keep these lines sterile and flowing.
“It is a highly skilled procedure and doctors have to undergo special training to achieve these skills and also keep them maintained by working in a clinical environment where they have to keep using them all the time,” says Dr. Sajith Kesavan, Senior Consultant and Head, Department of Paediatric Pulmonary and Critical Care.