CHENNAI: In India, up to 7 out of every 100 people contracting swine flu, succumb to it. On their death certificates, the cause of death is usually attributed to ‘respiratory failure’. To cut down on this margin, doctors at Apollo Hospitals attempted to give a 12-year-old patient with H1N1 a shot at improving her lung function, by putting her on an extra corporeal membrane oxygenation (ECMO) machine. Luckily for little Soubashree, after 19 days of intense treatment while on ECMO, it worked like magic. The child was kept on ECMO after being brought in with pneumonia on February 27, her lungs having failed even before she was brought to the Apollo Children’s Hospital.
She was shifted from Puducherry in a critical state, as her O2 levels were hovering under 50 per cent, despite getting 100 per cent supply externally. While on the road, her heart began to sink along with the lungs and the intensivist had his hands full trying to keep her alive with cardiac drugs. “He made a call and said ‘she needs ECMO asap’, and we agreed,” said Dr Indira Jayakumar, paediatric ECMO coordinator and consultant, Emergency and Intensive Care, Apollo Children’s Hospital.
Her father Balakumar recounted how there had been little hope while in Puducherry. “For one week, we went to a local doctor who just said it was fever and gave her tablets. After she began fainting, we took her to the Children’s Hospital there, where nobody was helping us. Finally, one of them saw her and asked why we’d brought her in such a critical state. They said there was no hope. A local MLA there suggested that we contact Apollo in Chennai and though we didn’t have too much hope, we called. I was skeptical whether anyone would come at 2 am, but a whole team landed up,” he said. ECMO is essentially a device that acts as an external heart-lung device, that takes the stress of both major organs. Usually used as a bridge for patients with end-stage heart or lung failure till a viable donor organ is available for transplant, the ECMO is now being looked at as a viable option for patients with acute respiratory failure with H1N1. “As soon as we put the patient on ECMO, the load is taken off the heart and the lungs. During this time, we aggressively target infections in the lung and get it to improve as soon as possible,” said Dr K Madhan Kumar, ECMO specialist and Heart and lung transplant surgeon, Apollo Hospitals. Apollo’s chairman Dr Prathap C Reddy and vice-chairperson Dr Preetha Reddy were present to celebrate the occasion with the family. The machine takes in dark, oxygenless blood from the body of the patient and oxygenates it outside, before sending it into the body again. It can be used on a patient for up to 90 days, though patient conditions have been known to deteriorate after the 35 day mark. Expensive to the extent where it costs more than `1 lakh a day, Apollo is planning a paediatric programme for children, who need ECMO at subsidised costs, called CARES. “We’re looking at setting up a trust so that children under the age of 16, who are quite at risk for respiratory trouble, can have access to lifesaving technology like ECMO at a subsidised cost. This will save plenty of lives,” said Dr Paul Ramesh, ECMO director and heart and lung transplant surgeon.