Background: Very limited data have been published for Extracorporeal membrane oxygenation (ECMO) in patients of COVID-19 from India. We have conducted this survey-based study to understand the challenges faced during ECMO management of COVID-19 patients in India. Materials and methods: This was a retrospective, multicentered, observational study conducted through a questionnaire-based survey. The survey addressed hospital characteristics, their experience of ECMO, and the various challenges faced during ECMO management of COVID-19 patients. The main four categories were technical challenges, operational challenges, clinical challenges, and major complications during ECMO of these patients. These challenges were probed in relation to the first and second waves of COVID-19 pandemic separately. The questions related to challenges faced during ECMO were ranked questions. Results: In total, 22 hospitals have responded to the survey. Almost 60% of the participant hospitals were doing less than 10 ECMOs per year before COVID-19 pandemic. Limited availability of ECMO machines and the cost of ECMO therapy were the major technical challenges faced, both in the first and second waves. Resistance from staff to work and risk of getting cross-infection with other team members were serious operational challenges during the first wave, while high workload, limited staffing, and difficulty in transporting patients were challenges in the second wave. Difficulty in counseling, an apprehension/hesitancy in medical colleagues, lack of public awareness, and limited evidence in favor of ECMO therapy were the clinical challenges faced during the first wave, while complications during ECMO, and poor outcomes were the common clinical challenges faced during the second wave. Hospital-acquired sepsis was the most severe complication faced in both waves. Conclusions: Managing ECMO in COVID-19 patients was found to be a challenging task. Sharing pre-ECMO strategies and protocols across usual referral centers and increased collaboration between ECMO centers is warranted to improve the outcome of patients.

Introduction: Aluminum phosphide (ALP) toxicity causes high mortality, often implicated for suicidal purposes since it has no specific antidote. Release of phosphine upon ingestion leads to refractory cardiogenic shock and multiorgan failure, which are the highest predictors of mortality. Compared with conventional treatment, extracorporeal membrane oxygenation (ECMO) plays a significant role in such unsolved problems. Materials and methods: Retrospective study of 9 cases from 2021 to 2022 with an undetermined number of tablets consumed. On examination, all patients had arrhythmias, hypotension, ejection fraction (EF 10–20%), and severe metabolic acidosis. We divided our patients into groups A and B based on the time taken for initiating ECMO. In group A (4 patients) VA-ECMO was initiated within 6 hours. Group B (5 patients) patients had a delay in arrival and the late decision worsened their condition and ECMO was initiated after 8 hours of ingestion. Conclusion: Early initiation of ECMO seems to improve survival rates in ALP toxicity.

The recent past has seen a surge in extracorporeal membrane oxygenation (ECMO) usage and awareness among health care professionals. However, It is still thought that these complex modalities for managing critically ill patients is restricted to metros. Moreover awareness among healthcare professionals is crucial who are primarily managing these critically ill patients for timely advice for ECMO support. The best way to create awareness and encourage for research among the professionals is conferences. However, this is always challenging to organize an international event beyond the metros. This was the first ever South West Asian and African chapter Extracorporeal Life Support Organization (SWAAC ELSO) conference that was organized successfully from 10th to 12th March 2023 with high academic standards involving multiple specialties involved in ECMO management and care.

Background: We report a case of severe traumatic brain injury with acute respiratory distress syndrome (ARDS) and air leak, in a child, who was successfully managed with venovenous extracorporeal membrane oxygenation (VV-ECMO) and made a good recovery. Patients and methods: This is a single case report from the pediatric intensive care at Manipal Hospitals, Bengaluru, Karnataka, India. Conclusion: We conclude that ECMO is feasible and safe for children with ARDS in the setting of severe traumatic brain injury (TBI). Timely initiation of ECMO can enable good recovery in children with severe ARDS and air leak complications, in the setting of trauma.

Coronavirus disease-2019 (COVID-19) acute respiratory distress syndrome (ARDS) management remains challenging for intensivists, especially during limited resource availability. We report a COVID-19 ARDS case who had hypercapnia in spite of appropriate ventilatory management. This case was successfully managed with the use of extracorporeal carbon dioxide removal (ECCO₂R) device with attaching pediatric oxygenator with continuous renal replacement therapy (CRRT).

Extracorporeal carbon dioxide removal (ECCO₂R) is a technique used in hypercapnic respiratory failure without much hypoxia. Here we have depicted a simple reproducible method of CO₂ removal using a conventional dialysis machine and oxygenator.