Extracorporeal Membrane Oxygenation (ECMO) is an invaluable lifesaving technology for critically ill patients who present with cardiac, pulmonary, or combined cardiopulmonary failure. These patients are the sickest in any critical care unit and are unable to maintain sufficient oxygenation and/or ventilation despite being on high ventilatory settings or experiencing refractory shock.

The ECMO machine consists of a pump and an oxygenator that replace the functions of the heart and lungs, respectively. The primary purpose of ECMO is to support these organs, giving them time to recover. ECMO is a supportive therapy, not a disease-modifying treatment, and allows the heart and lungs to rest.

As ECMO-related techniques and experience have improved, the concept of “Awake ECMO” is becoming the standard of practice for optimal patient outcomes. During “Awake ECMO,” patients breathe spontaneously without mechanical ventilator support and remain awake, allowing them to participate in physiotherapy and activities like sitting in a bedside chair. This approach addresses two major issues associated with traditional ventilated patients on ECMO, who typically require high doses of sedatives and paralytics, leading to immobility and almost universally resulting in critical illness myopathy/polyneuropathy. For patients with borderline respiratory function, “Awake ECMO” can make a crucial difference between life and death.

“Awake ECMO” is also ideal for patients on a bridge to transplant, as increased mobility and physiotherapy help preserve respiratory muscle function, cope with the stress of prolonged surgery, prevent atelectasis, and enhance postoperative recovery and survival.

Advantages of Awake ECMO:

• Improved tone of respiratory muscles and diaphragm, enhancing functional residual capacity
• Reduced V/Q mismatch
• Lower risk of ventilator-associated pneumonia (VAP)
• Early mobilization
• Better delivery of inhalational medications
• Increased patient engagement in spirometry
• Enhanced facilitation of physical rehabilitation
• Improved patient communication
• Greater participation in decision-making
• Reduced ICU psychosis

Patient outcomes in these complex cases worldwide are best in high-volume centers. Yashoda Hospitals has one of the highest series of Awake ECMO cases, with over a hundred such cases since the COVID pandemic, comparable to the best centers globally. With a dedicated Advanced Lung Failure Unit and multidisciplinary daily rounds by intensivists, specialty doctors, perfusionists, respiratory therapists, physiotherapists, dietitians, specialized nursing staff, and other teams, Awake ECMO has become the standard of care for the sickest patients at Yashoda Hospitals. This has led to some of the best patient outcomes, including successful home discharges after months on Awake ECMO and subsequent lung transplantation.

Yashoda Hospitals is one of the largest quaternary healthcare providers in the country, with the capability to perform onsite ECMO cannulation and provide air ambulance transfer for patients from across the country or internationally.