The Department of Cardiac Thoracic & Vascular Surgery at Excelcare Hospitals led by Dr. Manuj Kumar Saikia (Chief Cardiac Surgeon) & Dr. Intekhab Alam (Consultant Cardiac Surgeon) successfully instituted VV ECMO (Veno-Venous Extra Corporeal Membrane Oxygenation) an extremely high-risk procedure for a COVID Pneumonia Patient as an emergency life-saving procedure, a first in the Northeast.
The patient, a 61-year-old female from Jorhat tested positive for COVID19 and was admitted at Excelcare Hospitals on 23rd April for treatment. During the course of her stay in the hospital, there was rapid progression in the disease and the patient had to be shifted to the COVID ICU for intensive treatment as she developed COVID-related ARDS (Acute Respiratory Distress Syndrome). Due to her highly critical condition, she was under the constant supervision of a highly specialized team of doctors consisting of Pulmonologist, Internal Medicine specialists, Intensivists, Cardiologists, and Interventional Radiologists.
"Despite our best efforts the patient's condition was deteriorating rapidly. Her pneumonitis was progressing so rapidly in spite of antiviral therapy and steroids that it was becoming more and more challenging to maintain a steady oxygen saturation. The patient descended into the dreaded Cytokine Storm and had to be put on Bi-PAP (Bilevel Positive Airway Pressure) ventilation. Cytokine Storm is a severe immune reaction in which the body releases too many cytokines into the blood too quickly. Cytokines play an important role in normal immune responses but having a large amount of them released in the body all at once can be life threatening and rapidly damages the delicate pulmonary membrane through which gas exchange takes place." said Dr. Satyaki Saikia (Consultant-Internal Medicine).
CT Scan of the chest showed that there was severe damage to the lungs. Dr. Raj Changkakoty (Interventional Radiologist) said "The first CT Scan done on 24th April showed that there was mild pneumonia in the lungs, with CT Scan Severity Score (CTSS) of 9/25 (Mild to Moderate). She was deteriorating rapidly and the next CT which was done on 6th May revealed severe inflammation and congestion in the lungs with a revised CTSS of 23/25. Only 8% of her lungs were functioning, the reason why she was not able to maintain adequate oxygen saturation (70-75%) despite being on Bi-PAP Ventilation."
Dr. Manuj Kumar Saikia said, "This was a very challenging case as there was very high risk of complications and condition of the patient was very fragile. It was a question of survival as being on prolonged ventilation could further cause great stress to the lungs. That is when the team of doctors consulted our Cardiac Surgery team to explore the possibility of instituting ECMO in this particular case. After proper assessment of the risks involved and consultation with the expert team of doctors which included Cardiologists, Pulmonologist, Cardiac Anaesthesists, Intensivists and Interventional Radiologists, we took the decision and went ahead with the procedure after taking a 'High Risk Consent' from the family members."
Dr. Intekhab Alam said, "A vast majority of intensive care admissions following infection from SARS CoV2 are due to 'Hypoxaemic Respiratory Failure i.e, fall in Oxygen Saturation (<85-90%) with up to 88% of patients requiring ventilator support. A proportion of these patients fail maximal conventional therapies and require Extra Corporeal Membrane Oxygenation (ECMO) support.ECMO or Extra Corporeal Membrane Oxygenation is a form of Advanced Life Support System, where patients withdamaged lungs are supported on an artificial machine."
Dr. Neil Bardoloi (Chief Cardiologist) said "The patient in question is now stable and maintaining 100% oxygen saturation. Her condition is being closely monitored 24×7 by team of Intensivists led by Dr. Brajen Sharma. This is the beginning of an emerging paradigm in the treatment of severely and critically ill patients in this region which otherwise had to accept the fate of nature or had to travel outside the state for the same, which is not possible at this point in time. This facility in Excelcare Hospitals has not only opened up a new era in the treatment of critically ill patients in Assam and adjoining regions but has also raised the standard of treatment to be at par with the best National and International standards."
