- First case of successful ECMO treatment to a Covid19 patient in South India
- Third in the country to report, after 2 cases in Kolkota
- Patient was put on Ventilator for 35 days and on ECMO for 12 days
A 35-year-old paediatrician from Warangal claimed to have become the first COVID-19 patient from South India to have survived after being put on Extracorporeal Membrane Oxygenation (ECMO) support for the 12 days. It is not always possible to clinically manage respiratory distress in COVID-19 patients with ventilator support alone and ECMO is the last option for them.
Dr Dayanad Sagar, a 35yr young paediatrician from Warangal had contracted Covid-19 and had rapidly worsening oxygen levels. So he called up his doctor friends at CARE Banjara in Hyderabad and was admitted in the ICU. He was initially managed on High flow nasal cannula device for oxygenation and started on antivirals and medications for Covid-19. His chest CT scan was concerning with significant severity of COVID-19 pneumonia and he soon worsened to develop ARDS and he knew he was running out of breath and he realized he needed to be put on a ventilator.
He discussed with the critical care team treating him and he was placed on the ventilator. He was also put on complete sedation on Ventilator on prone position for 16hrs every day for one week and he showed some improvement and was monitored closely every day. He underwent a procedure called tracheostomy to connect ventilator through a small tube through his throat so that he could be cared for with mild sedation for prolonged ventilator support. But his oxygenation deteriorated further and he was not responding despite maximum ventilator support. His family, friends and colleagues, were all worried that he was not responding and Options were running out and fast.
Dr Pavan Kumar Reddy, the Chief Intensivist and his team decided to put Dr Dayanand on ECMO (Extra-Corporeal Membrane Oxygenation), a method in which blood is drawn out of body and oxygen mixed in the blood directly using a special by-pass pump-circuit and given back. The dilemma Dr Pavan and his team faced were that Dr Dayanand was already on a ventilator for 18 days and was unclear of when his lungs would recover and he would need ECMO support till his lungs improved and Covid-19 as a disease posed multiple challenges for ECMO. With the help of the cardiothoracic surgical team, the ICU room was converted into a mini-operation room and ECMO was instituted.
Dr Pavan and his team again faced a new challenge. The ECMO circuit requires continuous heparin infusion to prevent even any clot formation as the blood is pumped out of the body and covid-19 is known to cause increased blood clot formations and has a high resistance to heparin, the anticoagulant that is regularly used. They had to use very high doses of heparin with very diligent and careful monitoring as the requirements of heparin continued to escalate, to prevent any clots. They put him on minimal settings on a ventilator and had to do repeated bronchoscopy to clear thick secretions from the lungs. After 12 days of being on ECMO, Dr Dayanand’s lungs started to improve and his oxygen continued to improve and he was taken off ECMO.
He was gingerly nursed and gradually with decreasing support, weaned off after 35 days on a ventilator and his tracheostomy was also removed. Dr Dayanand says he feels it was a miracle that he survived and thanked all his well-wishers and the team at CARE Banjara.