Ecmo is a treatment option for acute cardio-respiratory or isolated lung failure.
In cardio-repiratory failure it is used as artereo-venous ECMO and in Isolated lung failure it is used as veno-venous ecmo.
In artero-venous Ecmo, the venous blood is taken out and oxygenated externally and returned to the body via a major artery. This can support the lung and heart for almost a month.
In veno-venous Ecmo, the venous blood is taken out and oxygenated outside and returned to the body through venous system. This help to supplement the oxygenation of compromised lungs like viral pneumonia, organophosphorous poisoning, ARDS,etc.
LEFT VENTRICULAR ASSIST DEVICE
This is an implantable device with power source outside which help to enhance the ventricular function either for a short period or long period. Basically the force for ejection of heart is created by a centrifugal force generated by suitably arranged electromagnets. This can be used as either as bridge to transplant or as a destination therapy. This is an option in patients who are not candidates for transplantation or if it is contra-indicated.
Surgically this is connected between the left ventricle and aorta through a mini-thoracotomy. The power line will be exiting outside the body as the need for power is huge and need to be recharged regularly.
BI-VENTRICULAR ASSIST DEVICE
This is a device working on the same principle but help both the ventricles.
TOTAL ARTIFICIAL HEART
Now devices are available which can replace the entire heart. This becomes an option when both the ventricles fail, heart is not available or contra-indicated and left ventricular assist device is not enough. The total artificial hearts available in the market are Berlin heart and Syncardia. Like in left ventricular assist devices ,power source will be outside and need to be recharged quite frequently.
In terminal heart failure in a patient with an average life expectacy of 10 years remaining, heart transplantation is the first choice unless contra-indicated by age, renal diseases,kidney diseases,malignancy or contra-indication to immuno-suppressants and steroids. If heart transplantation is not possible only other options are considered.
HEART AND LUNG TRANSPLANTATION.
Heart and lung transplantation is considered when there is associated pulmonary hypertention or severe lung disease.