ECMO in India: From Heroic Rescue to Responsible Program

ECMO in India: From Heroic Rescue to Responsible ProgramIn less than twenty years, extracorporeal membrane oxygenation (ECMO) has shifted in India from a rare last-resort therapy to a more common part of critical, cardiac, and perioperative care.COVID-19 increased awareness and expanded ECMO capacity, though growth remains uneven, costly, and mostly unregulated.Currently, a few major centers lead innovation, but most areas lack adequate ECMO access. 1 For ECMO to become a fair and sustained solution in India, we must prioritize systems like rational indications, training, funding, and local cost reduction over technology alone.New uses, such as for cardiogenic shock during angioplasty and refractory poisoning, show both the promise and current inequity of ECMO access. 2,3ndia faces a choice-keep ECMO as a costly, niche therapy or develop it into a value-based service for select, reversible critical illnesses.Where are We Today?The Indian ECMO LandscapeIndia does not have a mandatory national ECMO registry, and usage remains mostly unmonitored.Reporting to international databases like ELSO is voluntary.While professional networks, workshops, and publications such as the Indian Journal of ECMO (IJECMO) exist, comprehensive national data are still limited. 2,3ost ECMO services are limited to major academic or corporate centers in metro areas, with minimal availability in smaller cities and much of eastern, central, and northeast India.Many regions lack ECMO entirely or rely on costly, delayed transfers.Despite India's high rates of ARDS, cardiogenic shock, and toxic emergencies, ECMO access remains highly restricted.COVID-19 increased adult VV-ECMO use in India.A multicenter study showed around 50% survival for severe COVID-19 ARDS patients on ECMO, with a median treatment of 17 days comparable to global results but at lower cost. 4Perioperative and pediatric ECMO are also growing, supporting complex surgeries and conditions like lung transplant and ECPR. 5 Despite this progress, significant structural limitations remain.