ECMO at Apollo Hospitals, Lucknow

Extracorporeal Membrane Oxygenation (ECMO) is one of the most resource-intensive therapies in modern critical care. It is offered at Apollo Hospitals Lucknow (Apollomedics Super Speciality Hospital, Kanpur?Lucknow Road) as part of a round-the-clock intensive care and cardiac sciences programme. The sections below explain when ECMO is considered, what it can and cannot do, how recovery is staged, and how families from Lucknow and the surrounding districts can plan an admission.

Why Families Consider Apollo Hospitals Lucknow for ECMO

• Apollo Hospitals group legacy: Apollo Hospitals began in 1983 and today operates one of Asia's largest private healthcare networks, with more than 70 hospitals, over 10,000 beds and more than 12,000 doctors across the group ? a scale that allows protocols, training and second opinions to be shared across centres.
• Multi-speciality critical care team under one roof: ECMO is never a single-doctor therapy. At Apollo Hospitals Lucknow, the ECMO pathway draws on intensivists, cardiac surgeons, cardiologists, cardiac anaesthetists, pulmonologists, nephrologists, neurologists, infectious disease specialists, perfusionists, ECMO-trained nurses and physiotherapists. The hospital's overall consultant pool runs into several hundred specialists across more than 40 specialities, with the senior critical care and cardiac sciences faculty carrying several decades of combined experience.
• 24x7 availability: The emergency department, critical care units, blood bank, cath lab and operating theatres function round the clock, which matters because the decision window for ECMO is often measured in hours.
• Technology: Centrifugal-pump ECMO consoles with heparin-coated circuits, point-of-care coagulation and blood gas testing, bedside echocardiography and ultrasound-guided cannulation, continuous renal replacement therapy (CRRT) that can be integrated into the ECMO circuit, bedside bronchoscopy, portable imaging and advanced haemodynamic monitoring.
• Both VV and VA configurations: Veno-venous ECMO for respiratory failure and veno-arterial ECMO for cardiac failure or cardiogenic shock, including post-cardiotomy support after complex cardiac surgery.
• Adults, and paediatric or neonatal escalation pathways: Adult ECMO is provided on site. Because paediatric and neonatal ECMO needs different cannulae, circuits and nursing ratios, suitability for a child is confirmed case by case by the paediatric intensive care team, with referral arranged where a specialised paediatric ECMO bed is more appropriate.
• Structured follow-up: Survivors are followed for post-intensive-care syndrome ? physical deconditioning, limb and cannulation-site problems, cognitive and mood changes ? through cardiac rehabilitation, pulmonary rehabilitation and physiotherapy services.
• Insurance and TPA desk on campus for cashless pre-authorisation, which is important because ECMO admissions are long and paperwork is continuous.

Apollo does not claim that ECMO guarantees survival. It is a supportive bridge, and outcomes depend heavily on the underlying illness, the patient's age and organ reserve, and how early support begins.

Overview

Extracorporeal Membrane Oxygenation (ECMO) is a life-saving procedure that provides cardiac and respiratory support to patients whose heart and lungs are severely compromised. At Apollo Hospitals Lucknow, we are committed to excellence, current technology and compassionate patient care, and we work to be among the region's dependable centres for ECMO. Our team of skilled specialists uses advanced ECMO techniques to work towards the best achievable outcomes for our patients, with honest communication at every stage. If you or a loved one is facing a critical health challenge, our experts can review whether ECMO is appropriate.

In simple terms, blood is drained from a large vein through a cannula, passed through a pump and an artificial membrane lung where carbon dioxide is removed and oxygen added, then returned to the body. If it is returned to a vein, the configuration is veno-venous (VV) and supports the lungs. If it is returned to an artery, it is veno-arterial (VA) and supports both the heart and lungs.

Why ECMO is Necessary

ECMO is a critical intervention for patients suffering from severe cardiac or respiratory failure. This procedure is often necessary in cases of:

• Severe Pneumonia: When the lungs are unable to provide adequate oxygenation despite maximal ventilator support.
• Cardiac Arrest: In selected situations where the heart cannot pump blood effectively, including extracorporeal CPR in suitable candidates.
• Post-Cardiac Surgery: To support patients recovering from complex heart surgeries when the heart cannot yet sustain circulation alone.
• Severe Asthma or COPD Exacerbations: When conventional treatments fail to stabilise the patient, particularly with life-threatening carbon dioxide retention.

The primary benefit of ECMO is its ability to temporarily take over the function of the heart and lungs, allowing these organs to rest and heal. This life-sustaining support can be crucial in improving the chance of recovery and in providing a bridge to further treatment.

Other situations in which ECMO is considered include acute respiratory distress syndrome (ARDS) from any cause, severe influenza or viral pneumonia, cardiogenic shock after a large heart attack, fulminant myocarditis, massive pulmonary embolism with shock, refractory arrhythmias, severe chest trauma, drowning-related lung injury, drug overdose with cardiac depression, severe hypothermia, and as a bridge to heart or lung transplantation or to a ventricular assist device.

What Current Guidelines Say

ECMO practice in India follows international consensus documents alongside Indian society guidance:

• ELSO (Extracorporeal Life Support Organization) General Guidelines for Adult Respiratory and Cardiac Failure ? the ELSO adult respiratory failure guideline (2017, with subsequent interim and 2021 COVID-19 updates) and the adult cardiac failure guideline remain the reference standards for indications, anticoagulation and circuit management. ELSO also publishes the widely used anticoagulation guideline, which has moved away from a single fixed activated clotting time target towards individualised, multi-test monitoring using anti-Xa levels, aPTT and viscoelastic testing.
• ISCCM (Indian Society of Critical Care Medicine) ? the ISCCM position statement and consensus guidance on extracorporeal life support, published in the Indian Journal of Critical Care Medicine, emphasises centre volume, trained ECMO teams, defined referral pathways and structured consent given the cost and complexity of ECMO in the Indian setting. ISCCM's 2024 consolidated ICU practice recommendations reinforce lung-protective ventilation, prone positioning and neuromuscular blockade as steps to be attempted before ECMO in ARDS.
• Indian Society for Extra Corporeal Technology (ISECT) and the Indian Association of Cardiovascular-Thoracic Surgeons contribute to perfusion standards and post-cardiotomy support practice.
• What changed recently: the emphasis has shifted from ECMO as a last resort to early consideration in severe ARDS after evidence from the EOLIA trial (2018) and its later Bayesian re-analysis; there is stronger emphasis on lower-intensity, individualised anticoagulation to reduce bleeding; early mobilisation and awake ECMO strategies are increasingly used where feasible; and extracorporeal CPR is now recommended only within strict time and eligibility criteria at experienced centres.

Guideline recommendations are graded and several rest on limited evidence. The treating team applies them to each individual rather than mechanically.

Risks of Delay

Timely intervention is critical when considering ECMO. Delaying this procedure can lead to severe complications, including:

• Organ Failure: Prolonged lack of oxygen can result in irreversible damage to vital organs.
• Increased Mortality Risk: The longer the delay, the higher the risk of death.
• Complications from Underlying Conditions: Conditions such as sepsis or ARDS can worsen without prompt treatment.

At Apollo Hospitals Lucknow, we understand the urgency of ECMO and are equipped to respond swiftly to critical situations. Our team is available 24x7 to assess and initiate ECMO therapy when appropriate, so that patients are not delayed by avoidable process gaps.

Equally important, ECMO started too late ? after prolonged high-pressure ventilation, established multi-organ failure or severe brain injury ? is far less likely to help. Early telephonic discussion with the ECMO team, even before transfer, is usually more useful than a late referral.

Benefits of ECMO

• Improved Oxygenation: ECMO delivers oxygen to the body so vital organs can continue to function.
• Reduced Workload on the Heart and Lungs: By taking over pumping and gas exchange, ECMO allows these organs to rest and potentially recover.
• Improved Survival in Selected Patients: Studies suggest that timely ECMO in carefully selected critically ill patients can improve survival compared with conventional support alone, though results vary by indication and centre.
• Bridge to Recovery or Definitive Treatment: ECMO can act as a temporary measure while a patient awaits recovery, a heart or lung transplant, or corrective surgery.
• Lung and heart protection: ECMO allows ventilator pressures and inotrope doses to be reduced, limiting further injury.

At Apollo Hospitals Lucknow, the ECMO programme is designed around individualised decision-making, with daily review of whether support is helping and whether it should continue.

Preparation and Recovery

Preparation for ECMO

1. Consultation: Discuss the condition and treatment options with our ECMO and critical care specialists.
2. Pre-Procedure Testing: Blood work, coagulation profile, blood grouping and cross-match, echocardiography, imaging and vascular assessment are done to judge suitability.
3. Understanding the Procedure: Families are taken through what to expect before, during and after ECMO, including the possibility that support may not succeed.

In a true emergency, several of these steps happen simultaneously at the bedside, and consent is taken from the nearest available relative.

Recovery After ECMO

• Follow Medical Advice: Adhere to the post-ECMO care plan given by the treating team.
• Gradual Activity: Begin with light activity and increase slowly as advised.
• Nutrition: Maintain a balanced, protein-adequate diet to support healing.
• Regular Follow-ups: Attend every scheduled review so progress and complications can be tracked.

Our team supports patients and families through each stage of recovery, which for many people is measured in months rather than weeks.

Timing of ECMO and the Pre-Procedure Phase

ECMO decisions are made on a compressed timeline. A typical sequence is:

ECMO Configurations and Alternatives Compared

Procedures Sometimes Performed Alongside ECMO

• Continuous renal replacement therapy (CRRT) for acute kidney injury or fluid overload, often connected into the ECMO circuit.
• Tracheostomy when prolonged ventilation is expected, to aid weaning and comfort.
• Bronchoscopy and lavage to clear secretions and obtain microbiological samples.
• Coronary angiography, angioplasty or stenting when a heart attack is the cause of shock.
• Pulmonary embolism treatment such as thrombolysis, catheter-directed therapy or surgical embolectomy.
• Cardiac surgery or valve intervention where a structural problem is driving the failure.
• Distal limb perfusion cannula or LV venting during VA ECMO to protect the leg or unload the heart.
• Chest drain insertion, pericardial drainage and wound management as needed.
• Circuit or oxygenator change if clots, poor gas exchange or haemolysis develop.
• Nutrition support via nasogastric or nasojejunal feeding, and early physiotherapy including in-bed cycling where safe.

Phase-by-Phase Recovery Timeline

These ranges are indicative. Individual courses vary widely with the underlying illness.

Returning to Normal Activity, Work and Sport

Return is guided by function, not by the calendar. The treating team usually looks for these markers:

• Household activity: able to walk within the house, use the bathroom and bathe with minimal help, and maintain oxygen saturation without supplemental oxygen at rest.
• Indian floor-level activities: squatting, sitting cross-legged on the floor, using an Indian-style toilet and sleeping on a floor mattress all need good quadriceps and hip strength plus safe standing balance. After weeks in an ICU bed, these are often the last abilities to return. Until then, a raised commode seat, a chair for bathing, a firm cot instead of a floor bed and a grab bar are practical modifications. Groin cannulation sites should be fully healed and pain-free before deep squatting is attempted.
• Stairs and outdoor walking: usually possible when the patient can walk continuously for 10?15 minutes on level ground without severe breathlessness.
• Desk or seated work: often considered around 2?3 months, sometimes part-time initially, provided concentration and stamina allow.
• Manual labour, farming, driving heavy vehicles: typically 4?6 months or longer, and only after strength, vision, reaction time and any anticoagulation risk have been reviewed.
• Driving: discuss individually. Sedation, weakness, seizures, arrhythmia risk and sternotomy healing all influence timing.
• Exercise and sport: begin with walking and breathing exercises under supervision. Non-contact aerobic activity is usually reintroduced first; resistance training, contact sport and competitive activity need clearance from the cardiologist or pulmonologist, especially for patients on blood thinners, with reduced heart pumping function or with residual lung scarring.
• Air travel and pilgrimage or long bus journeys: confirm with the treating doctor, as low cabin oxygen and prolonged immobility carry risk in the early months.

Reducing the Chance of Needing ECMO Again

ECMO treats a crisis; preventing the next crisis means treating the underlying disease.

• Complete treatment of the primary illness ? heart failure medication, valve or coronary intervention, inhalers and controller therapy for asthma or COPD, immunosuppression for myocarditis-related conditions, anticoagulation for clotting disorders.
• Vaccination as advised, including annual influenza and pneumococcal vaccination for high-risk adults, and COVID-19 vaccination per current national guidance.
• Complete stopping of smoking, bidi, hookah, gutkha and other tobacco; avoiding biomass smoke exposure in kitchens by using LPG and ventilation.
• Blood pressure, diabetes, cholesterol and weight control; salt restriction and daily weight monitoring in heart failure.
• Cardiac and pulmonary rehabilitation attendance, which is under-used in India but strongly associated with fewer readmissions.
• Early medical review for fever with breathlessness, chest pain, sudden swelling of legs or rapid weight gain, rather than waiting.
• Avoiding unsupervised stopping of medicines, and never stopping anticoagulants before dental or surgical procedures without asking the treating doctor.

Children, Older Adults and Other Special Situations

Children and newborns

Paediatric and neonatal ECMO uses smaller cannulae, different circuits and higher nurse-to-patient ratios. Common indications include meconium aspiration, persistent pulmonary hypertension of the newborn, congenital diaphragmatic hernia, severe bronchiolitis, myocarditis and support after congenital heart surgery. Whether a specific child can be supported at Apollo Hospitals Lucknow is decided by the paediatric intensive care and cardiac team on the day, and transfer to a dedicated paediatric ECMO unit is arranged when that is safer. Families should ask directly about paediatric ECMO availability at the time of referral.

Older adults

Age alone is not an absolute bar, but frailty, pre-existing kidney or liver disease, dementia, advanced cancer, severe peripheral arterial disease and poor baseline function all reduce the likelihood of benefit. Older patients face higher risks of bleeding, stroke, delirium and prolonged weakness, and rehabilitation takes longer. Many centres, including in India, weigh biological rather than chronological age.

Pregnancy and the postpartum period

ECMO has been used successfully in pregnancy and after delivery, for example in severe viral pneumonia, amniotic fluid embolism and peripartum cardiomyopathy. It requires joint obstetric, neonatal and critical care planning and careful anticoagulation management.

Joint family caregiving

ICU visiting is restricted for infection control, so nominate one or two consistent family spokespersons who attend every briefing, keep a written record and relay information to the wider family. This reduces confusion and repeated conflicting decisions. After discharge, share caregiving in planned shifts ? one person for night supervision, another for physiotherapy exercises, another for medicines and pharmacy runs, and one for finance and insurance follow-up.

If ECMO Is Not Chosen or Not Offered

ECMO is not right for everyone, and declining it is a valid decision.

• What continues: maximal conventional care ? ventilation, prone positioning, medicines for the heart, antibiotics or antivirals, dialysis if needed ? remains available.
• Likely course: in the most severe cases of refractory respiratory or cardiac failure, survival without extracorporeal support is low, and the treating team will say so plainly rather than leaving families to guess.
• When the team advises against ECMO: reasons may include irreversible underlying disease, severe brain injury, uncontrolled bleeding, advanced multi-organ failure, or absence of a realistic recovery or transplant pathway. In such situations ECMO can prolong dying rather than extend life.
• Comfort-focused care: symptom control for breathlessness and pain, dignified nursing, spiritual support and honest communication are offered, and families are supported through the decision.
• Second opinion: asking for one is reasonable and should not be seen as mistrust, though in an emergency it must be organised very quickly.

Factors That Influence the Cost of ECMO

ECMO is among the most expensive therapies in intensive care because costs accrue every single day of support. Apollo Hospitals Lucknow provides a written estimate and daily updates; for actual figures, speak to the billing counter, the insurance desk or the ICU coordinator. Independent price-aggregator figures are unreliable and should not be used for planning.

Insurance, Cashless Treatment and TPA Process in India

• Cashless vs reimbursement: if the insurer or TPA has an empanelment with the hospital, cashless can be initiated. Otherwise the family pays and claims reimbursement later with discharge summary, bills, investigation reports and payment receipts.
• Emergency pre-authorisation: ECMO is almost always an emergency admission. Inform the insurance desk within 24 hours of admission; the desk sends the pre-authorisation request with clinical notes. Approvals for ECMO are often given in tranches, with fresh requests as support continues ? expect repeated paperwork.
• Documents to keep ready: policy number and e-card, government photo ID (Aadhaar or PAN), employer or group policy details, previous discharge summaries, and the KYC of the person who will receive any reimbursement.
• Waiting periods: most indemnity policies carry an initial waiting period of about 30 days during which only accident-related claims are payable, plus specific-illness waiting periods of roughly 1?2 years and pre-existing disease waiting periods that commonly run 2?4 years depending on the product and on IRDAI norms. ECMO for a complication of a declared pre-existing heart or lung disease may be affected; ECMO after a road accident or trauma is usually treated as accident cover and is payable from day one.
• Sub-limits and deductions: policies may cap ICU charges, room rent or consumables. Proportionate deduction can apply if the room chosen exceeds the eligible category. Non-medical consumables are often excluded unless a consumables rider is held.
• Sum insured adequacy: a prolonged ECMO admission can exhaust a modest sum insured. Ask about corporate group cover, top-up or super top-up policies, and whether more than one policy can be used through the porting or multiple-claim route.
• Government schemes: coverage under Ayushman Bharat PM-JAY, CGHS, ECHS, ESIC, state schemes or railway panels depends on the hospital's current empanelment and on scheme package rates, which may not cover ECMO fully. Confirm eligibility with the hospital's TPA and scheme desk before assuming coverage.
• Practical tip: designate one family member solely for insurance liaison, keep a folder with every bill, and ask for interim bills every two to three days so there is no surprise at discharge.

Planning the Admission and What to Bring

• Identity and paperwork: patient's Aadhaar or other photo ID, insurance card and policy copy, referral letter, all previous records, ECGs, echo reports, CT films and discharge summaries.
• Medicine list: current prescriptions with doses, including blood thinners, insulin, inhalers and any herbal or over-the-counter products; note all allergies.
• Financial readiness: a means of paying the initial deposit, active net banking or cards, and contact details of the person authorised to approve expenses.
• For the family attendant: mobile phones and chargers, power bank, a notebook to record daily briefings, water bottle, a light blanket or shawl, spare clothes, prescription glasses and any personal medicines. Nights in a waiting area are cold in Lucknow's winter.
• What not to bring: valuables, jewellery, large amounts of cash, outside food into the ICU, or flowers and plants.
• Consent and decision-making: identify the next of kin who will sign consents and ensure they remain reachable. If the patient had expressed wishes about intensive treatment, tell the team.
• Blood donation: ECMO patients frequently need blood products. Arrange a list of eligible, willing donors among relatives early and coordinate with the blood bank.
• Home preparation for later discharge: a firm cot rather than floor sleeping, a raised commode seat, a plastic stool for bathing, non-slip mats, a walker, a pulse oximeter and a digital BP monitor, plus a weighing scale for heart failure monitoring.

Warning Signs That Need Urgent Review After Discharge

Return to the emergency department or contact the treating team immediately if any of these occur:

• Increasing breathlessness at rest, or oxygen saturation falling below the level advised for you
• Chest pain, palpitations, fainting or near-faint