Treating patients in critical conditions so that they have a chance to survive including improving the quality of life is the heart of the extracorporeal membrane oxygenation, better known as ECMO. It is an alternative medical technology that increases the chance of saving lives in the critical minute.

The Heart of Life

The heart is an organ that can suffer crisis at any time. The most common heart condition found in adults is ischemic heart disease, which affects men more than women. In addition, it is commonly found in men over the age of 40 and women over the age of 60. The majority of heart disease is due to deterioration of the blood vessels caused by prolonged high blood pressure. Although it may affect the entire body, vascular deterioration will manifest itself when it affects major organs, such as the heart, kidney or brain. Some patients may lose consciousness or have a heart attack because of acute arterial blockage, arrhythmia, or death before reaching the hospital because they never had a physical exam.

The Importance of ECMO

An extracorporeal membrane oxygenation or ECMO relieves the heart and lungs by pulling blood out from the patient and removing carbon dioxide in an oxygenated, temperature-controlled environment. It acts as a pump to return blood to the body and replaces the heart and lungs in cases where these organs cannot work properly.

How ECMO Works

An ECMO works by

• Pulling blood out from the patient through a large plastic tubing about the size of a thumb which is inserted into the arms, neck or legs. In some cases, it may be inserted directly into the heart through an open chest incision. However, most are inserted in the groin area all the way to the heart so that it does not damage the blood vessels and heart.
• At least two tubes are inserted: one to bring out the blood and the other for the return. Once blood is drawn out from the body and into the machine, it will be oxygenated and adjusted to the suitable temperature before being reintroduced into the body. For example, patients with fever or patients with cardiac arrest may need different temperatures of reoxygenated blood to preserve brain cells.
• Oxygenation can be lifesaving in patients with lung dysfunction, such as COVID-10 infection that destroys parts of the lungs. Using an ECMO allows the lungs to rest for awhile to buy some time by introducing oxygen to the blood. In principle, by putting oxygen into the blood outside the body and pumping back in again will help save lives of patients who suffer from any type of severe lung conditions.
• Once blood has been oxygenated, it will pass through a pump that funnels blood back into the body. This pump replaces the function of the heart. Therefore, if the heart is not beating in such case as a heart attack or ischemic heart disease, an ECMO pumps blood for the heart. Furthermore, an ECMO can be used to pump blood at adequate pressure during treatment and surgical preparation so that the patient has enough blood supplied to the brain and other organs.

The Pride of ECMO Award

Bangkok Heart Hospital utilizes the ECMO to help our patients with various conditions and has been recognized with the ELSO Award of Excellence in Extracorporeal Life Support in 2022, which is awarded to the ECMO team from hospitals that have ECMO services around the world. Hospitals that have received this award are mostly world-class hospitals in Europe and America, such as Mayo Clinic Rochester, Oregon Health & Science University, The Royal Brompton Hospital, University of Pittsburgh Medical Center, Boston Children’s Hospital, Cleveland Clinic, Duke University Hospital, Massachusetts General Hospital, Northwestern Memorial Hospital, Stanford Hospital and Clinics, The University of Chicago Medical Center.

Bangkok Heart Hospital is the third hospital in East Asia after National Taiwan University Hospital and Chonnam National University Hospital to receive this award. The criteria for consideration consists for seven areas of effective patient care:

1. Systems Focus – the readiness of the center and patient management system. 
2. Environmental Focus – the number of ICU beds and necessary medical equipment. 
3. Workforce Focus – number of staff involved in patient care  
4. Knowledge Management – training and competencies of the organization, knowledge sharing among medical personnel, such as conferences, consultations, or continuing education, etc.
5. Quality Focus – results of ECMO usage, period of usage, etc. compared to other ECMO service providers from around the world, as well as continuous quality improvement activities
6. Process Optimization – outcome reviews and adherent to process recommendation of the ECMO team at Bangkok Heart Hospital. Annual medical research to optimize the ECMO team performance periodically. 
7. Patient & Family Focus – Beyond patient care is family education and support. In some cases, psychologists and psychiatrists are included in the team to ensure that the patient and family can participate in the care as well. 

Bangkok Heart Hospital is ready to take care of all heart patients with cardio-thoracic specialists and a team of multidisciplinary specialists, including cutting-edge medical equipment for effective patient care. Especially in that critical life moment, technology can support heart patients at the right place and the right time to increase the chance of survival.