Additional Professor, Cardiac Anaesthesia
AIIMS, New Delhi
I would like to know something about extracorporeal membrane oxygenation. This is a newer concept I think which is evolving specially in terms of ICU patients. Will you like to tell us something?
Well extracorporeal membrane oxygenation or ECMO as it is fondly called is now going to be known as a stethoscope in every ICU, why because it is the therapy for a failing lung or a failing heart when despite the best surgery and supraoptimal medical care, the heart is not responding to any therapy then under the right circumstances and at the right time for the reversible pathology, ECMO is probably the answer in the ICU patient.
How does echo help in ECMO?
ECMO is the future stethoscope and echo is the present stethoscope. This is how I would and we all in our cardiac surgical team like to put it as why because echo is the window about what is the status of the heart and perioperatively from the transthoracic preop patient, the perioperative transesophageal echo where a probe is put just behind the heart into the esophagus of the patient. You get different windows, different views where what is happening to the cannulae, you have to for ECMO to be good, you have to choose the right patient and for the right patient the pathology has to be good. So there are some selection criteria. So to choose the patient let us say a patient who has failing heart and which the failing heart has been over a long period of time and there is a sudden stress and the sudden stress is a viral myocarditis. Now this patient will benefit from it more. So in patient selection, in the placement of the cannulas, in the maintenance of the ECMO, how is the ECMO flow doing that is very important because the cannulas get misplaced and in the post bypass period if there is a tamponade, if there is a thrombosis around the cannulas or if the patient is being weaned off ECMO and suddenly there is a bleeding, all this things are very nicely shown on echo. Echo during ECMO is to be done, it is difficult but under expert hands echo society is coming up with fellowship examinations like the Indian Association of Cardiothoracic Anesthesiologist. They are very lucky that echo for ECMO is becoming easy.
My last question will be regarding the role of simulation in health care?
It is an evolving thing. The society of simulation in health care started in Boston some 10 years back and we are very proud to say that at AIIMS and a lot of cardiologists and cardiac anesthetists from across the world and very senior members of cardiac anesthesia society from India itself have come together to form for the first time in Asia and in India what is known as the World Simulation Society. It has just been born and inaugurated by the health minister Dr. Harshavardhan on August 31, 2015 at New Delhi. The way to go is that simulation as I said the cardiac anesthetist is a pediatrician, is a pharmacist, is a cardiologist or physician and intensivist and is seeing surgery all the time. Parameters like resuscitation after cardiac arrest, parameters like crisis management in the operating room, parameters like echo both transthoracic and transesophageal and parameters like ECMO where you helping a perfusionist put the patient on the ECMO and how to wean him off. So these are all parameters that are closely associated with others. This simulation needs to be taught. It is complex and simulation to be taught needs good people who are well-versed in it. They are good academic people who are well-versed in that art. So under 11-12 banners simulation has come up in cardiac sciences and simulation in health care is the modern future of the way of learning and training in the country.
Thank you ma’am, thanks for your time and thanks for sharing your views.