In previous cases, we have seen how cases with the elderly- dementia due to fluid accumulation, women- Uterine fistula among others were treated with advanced surgical procedures. In the current case discussed below an 18-month-old from Raipur was treated with an advanced procedure. What made the case more complicated was the lack of facilities in Raipur and the need to transport her to Hyderabad, making this case a scenario straight out of a medical thriller.
An 18-month-old girl from Bhilai, Chhattisgarh, accidentally ingested a bottle of All-Out insecticide. After struggling to breathe, she was initially taken to a local hospital and then transferred to Raipur, where she was placed on a ventilator. Her condition worsened as her lungs began to fail Despite full ventilator support, she couldn’t breathe properly. The hospital in Raipur contacted KIMS Cuddles, Kondapur in Hyderabad. A specialized team of six, including two intensivists, a perfusionist, an ICU nurse, and a cardiac surgeon, flew to Raipur. Upon examination, they diagnosed severe chemical pneumonitis caused by hydrocarbons in the insecticide. As the ventilator was ineffective in oxygenating her body and her right side heart is failing severely (Severe right Ventricular Dysfunction with severe Pulmonary Hypertension), the team decided to use ECMO (Extracorporeal Membrane Oxygenation) to support her breathing and stabilize her condition.
ECMO can be implemented in two ways. Typically, the right femoral vein is cannulated, de-oxygenated blood is drawn, and then after oxygenation through ECMO returned through the right internal jugular vein, bypassing the lungs. If the heart is also compromised, de-oxygenated blood is drawn from the internal jugular vein, oxygenated via ECMO, and reintroduced via the Arch of Aorta to supply the whole body. Usually, blood is drawn from the femoral vein and returned to the femoral artery, which is simpler. However, in this case, due to the child’s weight of only 10 kg, ECMO was placed through the neck, bypassing both the lungs and the heart, making this procedure very rare.
After the procedure, the baby was transported via road ambulance to Raipur Airport and then transported via charter air ambulance to Begumpet Airport. From there, she was taken to KIMS Cuddles, Kondapur. She was on VA-ECMO for nine days, showing gradual improvement. Then, she spent another five or six days on a ventilator. Afterwards, she was placed on high-flow oxygen, and eventually low-flow oxygen. During this period, an infection was treated with antibiotics. After a total of 18 days of treatment, the baby fully recovered became active, and was discharged in good health with a normal neurological outcome on Thursday.
Transporting children on VA or VV ECMO from one location to another is extremely rare in kids, especially through neck cannulation, making this case one of the rarest in India. Over the past year, this is one of the few such cases nationwide. For children with heart issues and post-heart surgeries, post-operative ECMO is relatively common. However, in this baby’s case, the problem was with her lungs and heart, and she was very small. Using ECMO through the neck cannulation and transporting her from Raipur to Hyderabad without complications, and then from the airport to the hospital, was highly complex and challenging, showcasing the team’s exceptional expertise and precision.
Experienced cardiac and vascular surgeons ensured precise blood vessel cannulation. To date, six cases have involved VA-ECMO via neck cannulation at this hospital. This hospital is also capable of E-CPR which means putting patients on ECMO while doing cardiorespiratory massage. In total, they have done 15 ECMO in the last 3 years which is one of the largest series of ECMO in India for lung-related conditions. For better outcomes, we also restore blood vessels. KIMS Cuddles offers ECMO at very affordable rates, and through our “Little One” foundation, we provide financial assistance to underprivileged patients. This case demonstrates the hospital’s commitment to delivering high-quality care to all patients, regardless of their financial background.
Dr. Parag Dekate, Clinical Director Of Pediatrics & Head Of the Pediatric Intensive Care Unit, KIMS Cuddles, Kondapur said “The treatment provided significant support to her heart and lungs. The advanced facilities at KIMS Cuddles Kondapur, combined with the expertise of a highly skilled medical team, made it possible to transport her to ECMO from Raipur and treat her successfully.
The team that transported the child from Raipur included Dr Parag Dekate, Clinical Director Of Pediatrics & Head Of Pediatric Intensive Care Unit, Dr Kalyan and Dr Avinash Reddy, Cardiac surgeon Dr Sandeep Janardhan, Perfusionist Dayakar, and male PICU nurse Deepumone, surgical sister Nagasirisha. Dr Parag Dekate explained that upon arrival, the child received comprehensive and multi-disciplinary care from the KIMS Cuddles PICU team, nurses, and support staff. The coordinated efforts of these medical professionals, along with the air ambulance services provided by ICATT and the parent’s cooperation and trust ensured the child’s recovery.
The case again proves that Indian healthcare standards have improved significantly and today our surgical procedures are among the best in the world. One also needs to ponder the skewed availability of our healthcare infrastructure.
