Background: There is a lack of scientific evidence on the beneficial effects of proning in COVID-19 ARDS patients on venovenous extracorporeal membrane oxygenation (VV-ECMO). This is the first original article from India that compared the effects of prone positioning in patients in VV-ECMO, the indication of ECMO being COIVD-19-associated acute respiratory distress syndrome (ARDS). Methodology: In this single-center retrospective observational study, we divided the COVID-19-associated ARDS patients on VV-ECMO into 2 groups, the supine group, and the prone group. The primary outcome parameter was 30 days mortality. Secondary outcome parameters were the length of ICU stay, days on VV-ECMO, and duration of mechanical ventilation. Results: There was no statistical difference in mortality (p = 0.9) between the supine and prone groups. There were no statistically significant findings in the secondary outcome parameters too. Conclusion: Prone positioning did not show a statistically significant benefit in mortality in COVID-19 ARDS patients on VV-ECMO. Although, there was a numerically lower percentage of mortality in prone patients. Additionally in numerical terms, patients had shorter ICU stays, fewer days on VV-ECMO, and shorter duration of mechanical ventilation who were proned.

The story of the “Evolution of Extracorporeal Membrane Oxygenation (ECMO)” continues after the previous edition. In the 17th century, Robert Hooke was the first to conceptualize a process similar to ECMO. Many researchers and clinicians worked hard throughout the 19th and 20th centuries to build systems supporting gas exchange over a thin film of blood. Brukhonenko from Russia is worth mentioning as the system he built, called an “autojector” came close to the expectations of replacing the lung with a mechanical gas exchange system. All the experiments so far were on animals till Dr John Gibbon, in 1953, first used the heart–lung machine he made on a case of the atrial septal defect (ASD) for cardiac bypass. In 1954, Dr Walton Lillehei introduced the practice of controlled cross-circulation using a child with his biological parents.

The use of extracorporeal membrane oxygenation (ECMO) can be beneficial when conventional ventilation methods are unsuccessful. Here, we successfully managed a patient with advanced tracheal malignancy and impending airway obstruction by implementing venovenous ECMO (VV-ECMO) before performing a critical endotracheal procedure. The VV-ECMO was securely established through the right jugular vein and the left femoral vein, under local anesthesia. The placement of a tracheal stent was then performed under the guidance of a rigid bronchoscope and fluoroscopy. Extracorporeal membrane oxygenation effectively maintained adequate oxygenation and ventilation. Venovenous extracorporeal membrane oxygenation serves as a valuable tool in supporting airway interventions for complex tracheal pathologies, especially when conventional ventilation may not be sufficient or feasible.

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has emerged as a crucial intervention for severe myocarditis, particularly when the causative factors are reversible, such as viral infections or toxins. This report details a case of toxic myocarditis resulting from aluminum phosphide poisoning, successfully treated with VA-ECMO support. Notably, the ECMO was initiated while the patient was conscious. In the absence of effective treatments for this lethal toxin, VA-ECMO effectively maintained circulation despite severe arrhythmias. The patient recovered within 84 hours and was discharged without any lingering health issues.

Aim and background: There has been an exponential rise in the use of venovenous extracorporeal membrane (VV-ECMO) in patients who develop acute respiratory distress syndrome (ARDS), as observed in Indian hospitals. In spite of the ever-increasing cases of patients being treated with VV-ECMO, there is scarcity of literature about sedation management in this patient group. This retrospective, online questionnaire-based survey was undertaken with an aim of gaining an overview of what majority institutes in India are practicing with respect to sedation during VV-ECMO, so that it can contribute to the smallest extent in forming policies and protocols. Materials and methods: This survey was formulated on SurveyMonkey application and shared with members of ECMO society of India (ESOI) through WhatsApp. Their responses were recorded and analyzed through SurveyMonkey application. Results: Fentanyl was found to be the most widely used drug followed by midazolam and fentanyl plus midazolam was the most commonly used combination. Majority of participants (83.33%) use Richmond Agitation-Sedation Scale (RASS) for monitoring agitation. Only other scale being used is the Ramsay scale. Incidence of delirium was less than 10% in most intensive care units (ICUs). Majority of participants (54.17%) required deep sedation for less than 5 days to keep their patients calm and comfortable. Physiotherapy was given during both deep and light sedation in most of the units (60%). Conclusion: We found substantial uniformity with respect to choice of agitation scales used, initiation of physiotherapy, incidence of delirium and number of days on deep sedation among the centers across India. Clinical significance: Although this survey gives a glimpse of sedation practices in VV-ECMO in many centers across India, more surveys and studies are required on this topic.