ECMO Treatment in Bangalore - KIMS Electronic City

What ECMO does

Extracorporeal Membrane Oxygenation is a temporary heart-lung bypass that takes over gas exchange when the patient’s own lungs cannot. Blood is drained from a large vein, oxygenated by a membrane lung outside the body, warmed, and returned - either to a vein (VV, lung support only) or an artery (VA, combined heart + lung support).

ECMO does not treat the underlying disease. It buys time. The question that defines the case is what we use that time for - waiting for the patient’s own lungs to heal (bridge to recovery), or waiting for a donor lung to arrive (bridge to transplant).

The clinical decision that defines every ECMO case

Bridge to recovery = the underlying lung injury is expected to heal (severe ARDS from pneumonia, influenza, COVID, aspiration). Bridge to transplant = end-stage lung disease has decompensated and the native lungs will not recover. Same machine, two entirely different clinical pathways.

When ECMO is considered

The EOLIA trial (NEJM 2018) - the pivotal randomised trial - showed 60-day mortality of 35% in the ECMO arm vs 46% in conventional ventilation for severe ARDS (relative risk 0.76). Modern international guidance is to consider ECMO in severe ARDS with PaO₂/FiO₂ ratio below 80 despite optimal ventilation, or severe hypercapnic acidosis unresponsive to protective ventilation.

Typical scenarios:

Severe ARDS - from pneumonia (bacterial, viral including COVID and influenza), aspiration, post-operative lung failure, near-drowning, smoke inhalation, transfusion-related acute lung injury
Refractory hypoxia despite optimal ventilation - PaO₂/FiO₂ < 80 for 6+ hours on lung-protective settings + prone positioning
Severe hypercapnic acidosis - CO₂ retention with pH < 7.20 that cannot be corrected with lung-protective ventilation
End-stage lung disease with acute decompensation - patients on the transplant list who deteriorate faster than a donor arrives
Cardiogenic shock with respiratory failure - VA ECMO for combined support

VV vs VA ECMO - the mode decision

Factor	VV ECMO	VA ECMO
Primary problem	Lung failure only	Combined heart + lung failure, or cardiogenic shock
Cannulation	Venous drainage + venous return (femoral + jugular typical)	Venous drainage + arterial return (femoral vein + femoral artery)
Cardiac support	None - relies on native heart	Full biventricular support
Ambulation feasibility	Good (upper-body cannulation possible)	Limited (femoral arterial cannula anchors patient)
Anticoagulation	Lower (ACT 160-180)	Higher (ACT 180-220)
Typical use	Severe ARDS, bridge to lung transplant	Cardiogenic shock, primary graft dysfunction post-transplant

In most lung disease scenarios, VV is the correct choice. VA is reserved for combined cardiac-respiratory failure. The mode can be converted mid-course if clinical condition changes.

Awake ambulatory ECMO - the biggest advance

A patient lying sedated and ventilated for weeks while waiting for a donor loses muscle mass fast - ICU-acquired weakness sets in within 5-7 days of immobility - and arrives at the operating room markedly weaker than they would be otherwise. The single most important advance in bridge-to-transplant ECMO has been awake mobilisation.

At KIMS Electronic City, patients on ECMO routinely walk the corridor with a physiotherapist, eat meals, communicate with family, and participate in their own care plan. These patients have substantially better post-transplant outcomes - faster extubation, shorter ICU stays, faster rehabilitation.

The decision tree - day 3 to day 28

In practice, the line between bridge-to-recovery and bridge-to-transplant is rarely drawn at the moment of cannulation. Dr. Manjunath M Negigoudara revisits the question at fixed intervals:

Day 3-5: Is lung compliance improving? If yes, continue recovery pathway. If no, alert transplant coordinator.
Day 7: CT chest reassessment. If aerated lung is returning, begin weaning trial. If not, formal transplant evaluation starts in parallel.
Day 14: Trajectory usually clear. Either weaning + decannulation, or listed for transplant + optimising nutrition + mobilising.
Day 21: If still on ECMO by this point, recovery is unlikely. Aggressive rehabilitation, infection prophylaxis, family + funding coordination.
Day 28+: Cumulative complication risk (bleeding, thrombosis, infection, limb ischaemia, neurological events) rises steeply. Reassess candidacy carefully.

For the full clinical framing with EOLIA / JHLT bridge-to-transplant outcomes / Lancet COVID ECMO data, see the pillar guide: ECMO as bridge to recovery vs transplant.

Inter-hospital ECMO retrieval

If a patient with severe respiratory failure is too unstable to transport conventionally, the KIMS Electronic City ECMO team can perform inter-hospital retrieval - placing the cannulas at the referring hospital and bringing the patient on ECMO to Bengaluru. This is always higher-risk than initiating ECMO in the receiving ICU.

The single most useful step for referring intensivists: call +91 79937 41199 BEFORE the patient becomes too unstable to transport. Earlier conversations almost always lead to better outcomes. WhatsApp is the fastest channel for sharing imaging and PFT trends.

Cost of ECMO at KIMS Electronic City

ECMO adds approximately ₹5-15 lakh to a transplant admission, depending on duration and complications. This is separate from the lung transplant surgical package (₹36 lakh) and pre-transplant evaluation (₹4.5-6 lakh). Full cost breakdown + insurance mechanics + financing playbook: lung transplant cost in India + financing guide.

Book an ECMO or transplant discussion

Referring physicians: call before the patient becomes unstable. Records can be reviewed remotely.

Families: if your relative is on ventilator support at another hospital and the team is considering ECMO, WhatsApp Dr. Manjunath M Negigoudara with the current imaging and blood gases - a same-day second opinion is often possible.

Call +91 79937 41199 · WhatsApp · Book online. Also see: best lung transplant doctor in Bangalore, transplant pulmonologist in Bangalore.

Frequently asked questions

What is ECMO and when is it needed?

Extracorporeal Membrane Oxygenation (ECMO) is a temporary heart-lung bypass that takes over gas exchange when the patient's own lungs cannot. It is considered in severe ARDS with PaO2/FiO2 ratio <80 despite optimal ventilation, or severe hypercapnic acidosis unresponsive to protective ventilation. The EOLIA trial (NEJM 2018) established modern ECMO benefit: 60-day mortality 35% vs 46% conventional ventilation in severe ARDS.

What is the difference between VV and VA ECMO?

VV (veno-venous) ECMO supports the lungs only - blood is drained from a vein, oxygenated by the machine, and returned to the venous system. VA (veno-arterial) ECMO supports both the heart and lungs - oxygenated blood is returned into the arterial system. In lung disease without significant cardiac failure, VV is the usual choice.

What is bridge-to-recovery vs bridge-to-transplant?

Bridge to recovery uses ECMO to give the damaged lung time to heal (severe ARDS from pneumonia, influenza, COVID, aspiration). Bridge to transplant uses ECMO to keep a patient alive until a donor lung is available (end-stage IPF, COPD, post-COVID fibrosis). Same machine, entirely different clinical decisions. See Dr. Manjunath's full clinical guide.

Can patients on ECMO walk and eat?

Yes - in selected cases. Awake ambulatory ECMO is standard at KIMS Electronic City. Patients not requiring ventilation can sit, walk with assistance, eat real food, and participate in physiotherapy. This is the single biggest advance of the last decade in bridge-to-transplant ECMO - awake patients arrive at the operating room with much better outcomes than sedated ones.

How long can a patient stay on ECMO?

There is no fixed limit. Most patients are supported for 1-3 weeks; some have been on ECMO for several months. Duration depends on whether the underlying problem is reversible, nutritional and infection status, and access to transplant if recovery is not possible. Cumulative complication risk rises steeply after day 21, so decisions are re-evaluated weekly by Dr. Manjunath M Negigoudara and the KIMS team.

How much does ECMO cost at KIMS Electronic City?

ECMO adds approximately ₹5-15 lakh to a transplant admission at KIMS Electronic City, depending on duration and complications. This is separate from the lung transplant surgical package (₹36 lakh) and pre-transplant evaluation (₹4.5-6 lakh). See our full cost guide.

Is inter-hospital ECMO retrieval available?

Yes. If a patient is too unstable to transport conventionally, the KIMS Electronic City ECMO team can perform inter-hospital ECMO retrieval - placing cannulas at the referring hospital and transporting the patient already on ECMO to KIMS. This is always higher-risk than initiating ECMO in the receiving ICU, so earlier calls to Dr. Manjunath M Negigoudara (+91 79937 41199) are always better.