ECMO & Emergency ICU Care in Jaipur | Apex Hospitals
When the Heart or Lungs Fail: Understanding ECMO and 24/7 Emergency ICU Support
A plain-language guide to Extracorporeal Membrane Oxygenation — what it is, who needs it, and how Apex Hospitals Jaipur delivers round-the-clock critical care when it matters most.
By the Apex Hospitals Clinical Team · Published July 2025
What Exactly Is ECMO — and Why Does It Exist?
Extracorporeal Membrane Oxygenation — ECMO — is one of the most powerful life-support technologies available in modern critical care. At its core, it is a machine that temporarily takes over the work of the heart, the lungs, or both, giving the body time to heal from a catastrophic illness or injury. Blood is drawn out of the body, passed through an artificial membrane that adds oxygen and removes carbon dioxide, and then returned — warm and oxygenated — back into circulation.
ECMO is not a treatment in itself; it is a bridge. It buys clinicians the hours or days needed to treat the underlying cause — whether that is a severe viral pneumonia, a massive heart attack, or a post-surgical cardiac crisis — without the organs suffering irreversible damage from oxygen starvation.
According to the Extracorporeal Life Support Organization (ELSO), global ECMO use has grown more than tenfold over the past two decades, driven by improved circuit technology, better patient selection, and the hard lessons learned during large-scale respiratory crises. In India, access to ECMO has historically been concentrated in a handful of tertiary centres — making institutions like Apex Hospitals Jaipur critically important for patients across Rajasthan.
The Two Types of ECMO: VV and VA
Understanding the difference between the two main ECMO configurations helps patients and families grasp why the technology is prescribed in specific situations.
Veno-Venous (VV) ECMO — Lung Support
VV ECMO is used when the lungs have failed but the heart is still pumping adequately. Blood is drawn from a large vein, oxygenated by the machine, and returned to a different vein. The heart then circulates this freshly oxygenated blood around the body. Conditions that may require VV ECMO include severe ARDS (Acute Respiratory Distress Syndrome), refractory pneumonia, and pulmonary embolism with respiratory collapse.
Veno-Arterial (VA) ECMO — Heart and Lung Support
VA ECMO is deployed when both cardiac and respiratory function are compromised. Blood is drawn from a vein and returned directly into an artery, effectively bypassing both the heart and lungs. This configuration is used in cardiogenic shock, cardiac arrest that does not respond to conventional resuscitation (ECPR), myocarditis, and post-cardiotomy failure. The American Heart Association recognises VA ECMO as a key rescue strategy in refractory cardiogenic shock when other haemodynamic support has been exhausted.
Apex Hospitals operates both VV and VA ECMO machines, enabling the ICU and critical care team to match the precise support modality to each patient's physiology.
Who Needs Emergency ECMO? Recognising the Warning Signs
ECMO is reserved for patients whose condition is immediately life-threatening and has not responded to maximum conventional therapy — mechanical ventilation, vasopressors, inotropes, and other ICU interventions. Families should be aware of the clinical scenarios that may prompt an ECMO discussion:
Severe ARDS — oxygen levels remain dangerously low despite high-pressure ventilation
Refractory cardiogenic shock — the heart cannot pump enough blood to sustain organ perfusion
Cardiac arrest unresponsive to CPR — ECMO-assisted CPR (ECPR) can maintain circulation while the cause is identified and treated
Massive pulmonary embolism — a large clot blocks blood flow through the lungs
Severe myocarditis — inflammation of the heart muscle causes acute pump failure
Post-cardiac surgery failure — the heart struggles to resume independent function after open-heart surgery
Drug overdose or poisoning — certain toxins cause reversible cardiac or respiratory collapse
Speed of initiation is critical. The sooner ECMO is established in an eligible patient, the greater the chance of organ recovery. This is why having an ECMO-capable centre — with trained perfusionists, intensivists, and surgeons available around the clock — is not a luxury but a necessity.
What Happens During an ECMO Run? A Step-by-Step Overview
For families watching a loved one on ECMO, the sight of tubes, pumps, and monitors can be overwhelming. Here is a simplified walkthrough of what the care team is doing:
Cannulation — Large catheters (cannulas) are placed into major blood vessels, usually in the neck or groin, under local or general anaesthesia. This is a surgical procedure performed by a trained vascular or cardiac surgeon.
Circuit priming — The ECMO circuit is filled with a priming solution and connected to the patient. A centrifugal pump drives blood through the oxygenator membrane.
Oxygenation and CO₂ removal — The membrane lung adds oxygen and strips out carbon dioxide, mimicking healthy lung function. In VA mode, the pump also replaces cardiac output.
Continuous monitoring — Intensivists and perfusionists monitor blood gases, flow rates, anticoagulation levels, and haemodynamics continuously. Targets are adjusted in real time.
Weaning — As the heart or lungs recover, ECMO support is gradually reduced (weaned). If the patient's own organs can sustain adequate function, the cannulas are removed and the circuit is discontinued.
Decannulation — Cannulas are removed, vessels are repaired, and the patient transitions to standard ICU monitoring.
An ECMO run may last anywhere from a few days to several weeks, depending on the underlying condition and the pace of organ recovery. Throughout this period, the ECMO and critical care specialists at Apex Hospitals coordinate closely with cardiologists, pulmonologists, and other subspecialists to address the root cause of organ failure.
ECMO Outcomes: What the Evidence — and Apex's Own Data — Show
Survival rates on ECMO vary considerably depending on the indication, patient age, and time to initiation. For VV ECMO in severe ARDS, published registry data suggest survival to hospital discharge in the range of 50–65% for appropriately selected patients — outcomes that would be near zero without ECMO support. VA ECMO for cardiogenic shock carries a more variable prognosis, reflecting the severity of the underlying cardiac disease.
At Apex Hospitals Jaipur, the ECMO programme has achieved an 80% survival rate in ECMO cases — one of the strongest documented outcomes in Rajasthan. This figure reflects not only the technology but the experience of the multidisciplinary team, the 24×7 availability of perfusionists, and the integration of ECMO care within a fully equipped Advanced ICU that also houses CRRT machines for kidney support, vasopressor protocols, and continuous neuromonitoring.
It is important to approach these numbers honestly: ECMO is not a guarantee of survival, and not every patient is a candidate. The decision to initiate ECMO involves careful ethical and clinical deliberation, including discussions with the patient's family about goals of care, likely trajectory, and quality of life after recovery.
The Broader ICU Ecosystem: ECMO Does Not Work in Isolation
ECMO is only as effective as the ICU surrounding it. A patient on ECMO simultaneously requires mechanical ventilation management, anticoagulation monitoring, nutritional support, infection prevention, renal replacement therapy if the kidneys are affected, and neurological assessment. This is why ECMO outcomes are strongly correlated with the overall quality of the critical care unit.
Apex Hospitals Malviya Nagar operates a dedicated Cardiac ICU, Trauma ICU, and Neuro ICU alongside its Advanced ICU with ECMO capability. The hospital's cardiology specialists and cardiothoracic surgeons work alongside intensivists to manage the cardiac dimensions of ECMO care, while the nephrology team oversees renal replacement therapy for patients who develop acute kidney injury — a common complication in critical illness.
The hospital's on-site CT scan, MRI, X-ray, and emergency laboratory services mean that diagnostic imaging and blood results are available within minutes, not hours — a decisive advantage when managing rapidly evolving critical illness.
The HOPE Tele-ICU: Extending Critical Care Beyond Jaipur
One of the most significant innovations at Apex Hospitals is the HOPE Tele-ICU Command Centre — a 24×7 remote ICU monitoring and consultation platform that connects 18 partner sites across Rajasthan. Recognised in Harvard Business Review and honoured at the GovConnect Conclave for HealthTech Excellence, HOPE allows Apex's senior intensivists to supervise critically ill patients at district hospitals and smaller facilities in real time.
For ECMO specifically, HOPE plays a vital role in early identification and rapid transfer. When a patient at a partner site deteriorates beyond the capacity of local resources, the Tele-ICU team can assess the case remotely, initiate transfer protocols, and prepare the Apex ECMO team before the patient even arrives. This coordination compresses the time-to-cannulation window — a factor that directly influences outcomes in conditions like ECPR and refractory shock.
The programme has also been recognised as a USAID Grant Winner and received the Digital Transformation Award 2022, reflecting its impact on healthcare access across the region. Patients and families in Sawai Madhopur, Jhunjhunu, Bikaner, Sri Ganganagar, and beyond can reach Apex's ECMO expertise through this network — reducing the cost burden by an estimated ₹40,000–₹50,000 per day compared with uncoordinated transfers to distant metro centres.
Recovery After ECMO: What Patients and Families Should Expect
Surviving ECMO is a significant achievement — but it is the beginning of a recovery journey, not the end. Most patients who come off ECMO have spent days or weeks in a deeply sedated, immobile state. Muscle wasting, cognitive changes, and psychological distress (including ICU-related PTSD) are well-documented sequelae of prolonged critical illness.
Apex Hospitals addresses post-ECMO recovery through its in-house physiotherapy and rehabilitation unit, which begins mobilisation as early as clinically safe — sometimes while the patient is still in the ICU. Nutritional support, coordinated by the dietetics and nutrition team, is tailored to the metabolic demands of recovery. Psychological support is available through the psychiatry department for patients and family members who have experienced the trauma of a near-fatal illness.
The goal is not merely discharge from the ICU — it is a return to meaningful function and quality of life. This requires a coordinated, multidisciplinary approach that extends well beyond the ECMO machine itself.
Frequently Asked Questions About ECMO and Emergency ICU Care
Is ECMO painful for the patient?
Patients on ECMO are typically sedated and on mechanical ventilation, so they are not conscious of the cannulas or the circuit. Pain management is a core part of ICU care, and the team continuously adjusts sedation and analgesia to keep the patient comfortable while allowing enough wakefulness for neurological assessment.
How long can a patient stay on ECMO?
There is no fixed maximum duration. Most ECMO runs last between 5 and 21 days, but some patients — particularly those awaiting heart transplantation or ventricular assist device implantation — may remain on ECMO for longer. The decision to continue or withdraw support is reviewed daily by the clinical team in consultation with the family.
What are the main risks of ECMO?
ECMO carries real risks, including bleeding (because anticoagulants are required to prevent clotting in the circuit), thromboembolism, infection at the cannula sites, limb ischaemia, and neurological complications. These risks are managed through meticulous monitoring and are weighed against the near-certain death that would result without ECMO in eligible patients.
Does Apex Hospitals accept insurance for ECMO treatment?
Apex Hospitals is empanelled under Ayushman Bharat and accepts major insurance and TPA schemes. Families should contact the hospital's billing and insurance desk at the earliest opportunity so that pre-authorisation can be sought in parallel with clinical care — delays in paperwork should never delay life-saving treatment.
Can a patient be transferred to Apex Hospitals Jaipur for ECMO from another city?
Yes. Apex operates equipped ambulance services and, through the HOPE Tele-ICU network, can coordinate inter-facility transfers across Rajasthan. In some cases, the ECMO team can advise on stabilisation measures at the referring hospital before and during transport. Families should call 098290 30011 immediately to initiate the transfer process.
What conditions make a patient ineligible for ECMO?
ECMO is generally not offered when the underlying condition is irreversible and no further treatment options exist, when the patient has a terminal illness with a very short prognosis, or when there are absolute contraindications to anticoagulation. Age alone is not a contraindication — ECMO is used in neonates, children, and adults. Each case is evaluated individually by the clinical team.
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Facing a Critical Care Emergency?
Apex Hospitals Jaipur's ECMO and ICU team is available 24 hours a day, 7 days a week — call us immediately or visit our emergency department at Malviya Nagar.