16-year-old tuberculosis patient shows signs of recovery after seven weeks on ECMO
BENGALURU: In a rare case, a 16-year-old girl was put on ECMO (extracorporeal membrane oxygenation) treatment (a machine that does the work of the heart and lungs for a patient) for seven whole weeks after she contracted tuberculosis.
She was referred from another hospital where she was admitted with respiratory issues, fever, cough and pneumonia. Her lungs were damaged and no amount of ventilatory support or medicines were improving her oxygen levels. When the lungs are affected, the heart follows suit. Her blood pressure dropped and she was on multiple high-dose medications to maintain acceptable blood pressure levels. There was a risk of the ventilatory and other support damaging the organs, hence ECMO was presented as an alternate option. The doctors discussed it with the family and they agreed to it.
"Seven weeks is a long time for anyone to be on the ECMO. It is meant to give rest to the heart and lungs until they recover. Putting children on ECMO is not common and even if they are, it is usually for a maximum of two weeks. It is generally done post-heart surgery in children. This situation was unusual as she did not undergo any surgery," said Dr Shivakumar Shamarao, Consultant - Paediatric Intensive Care Unit (PICU), Manipal Hospitals.
For the 16-year-old, it was a stormy course. The patient had developed an infection, kidney failure needing dialysis, bleeding complications, which is a risk factor of ECMO owing to the high dose of blood thinners in addition to the liver dysfunction. The long time it was taking for her lungs to recover stumped doctors and they even discussed it with international centres offering ECMO but they could get no answer on how long they should let her be. Since they could not rule out chances of recovery and the family was hopeful, they went on with it.
"It took five weeks for her to show signs of recovery. Gradually the ECMO support was brought down along with an increase in the ventilator support. The patient was then taken off the ventilator following which she underwent a tracheostomy to help her breathe easy. She was discharged after nine whole weeks. She will be on oxygen support at home while continuing with her tracheostomy tube since her lungs are yet to recover completely. The patient follow-ups will continue until we deem her lungs are fit," Dr Shamarao said.
Stating that ECMO gives a 50 percent chance of survival, Dr Shamarao also said that some people including those in the medical community wrongly believe that if a patient is on ventilator, there is no coming back. He explained that there needs to be more awareness on this option and its utilisation at the right times.
Cost is a limiting factor as ECMO charges are between Rs 50,000 to a lakh per day. The only way to overcome this is through improving the technology that requires affordable machinery, Indian infrastructure, government and private support, he added.