After complex heart surgery, their hearts failed: The 110-hour ECMO battle that saved two babies

Baby Rachel was 10 months old and weighed 5.4 kg when she was brought to the hospital in Kolkata. Her mitral valve had been leaking severely, driving her into heart failure that medication could no longer control. She also had a large hole between the upper chambers of her heart. Surgery was the only option, and it went without complication. But when the team attempted to separate her from the heart-lung machine that had sustained her through the procedure, her heart would not take over. It could not.

Eight-month-old Baby Sweety arrived with a similar weight and a different but equally serious picture. Large holes between both the upper and lower chambers of her heart had caused pulmonary pressure to rise to dangerous levels. Her surgery was completed. Her heart, too, failed to resume independent function when the team tried to wean her from bypass support.

In both cases, the same conclusion was reached: the only remaining option was ECMO. Extracorporeal Membrane Oxygenation is a modified, highly advanced form of the heart-lung machine. It takes over the function of the heart and lungs entirely, circulating and oxygenating blood outside the body while the organs it is supporting have time to recover. The decision to initiate it was made in consultation with the full clinical team and with both sets of parents. With the sternum left open and ECMO cannulas placed directly into the right atrium and the aorta of each infant, the team moved both children from the operating theatre to the ICU with the machines running.

What followed was 110 hours of continuous, high-stakes management for each child. ECMO in infants carries competing risks that have to be held in balance simultaneously across every hour of support. The circuit requires blood thinners to prevent clotting, but those same medications increase the risk of bleeding. Every organ system has to be monitored continuously. Infections have to be prevented. Cardiac recovery has to be assessed daily through echocardiography, with the team watching for the point at which the heart is strong enough to be weaned from support. That point arrived for both infants at around the 110-hour mark. Weaning was successful in both cases and both the children recovered.

Dr Kuntal Roy Chowdhuri, Senior Consultant, Paediatric and Adult Cardiac Surgery, BM Birla Heart Hospital, said, "Post-cardiac surgery ECMO in infants is among the most demanding interventions in paediatric cardiac care. Early initiation and precise multidisciplinary management are what determine outcomes in these cases. The recovery of both these children reflects what coordinated, high-level cardiac care can achieve even in the smallest and most critically unwell patients."

Dr Satarupa Mukherjee, Consultant, Paediatric Cardiac Intensive Care, BM Birla Heart Hospital, said, "Managing bleeding and clotting simultaneously while monitoring every organ system across days of ECMO support requires a level of clinical vigilance that cannot be reduced to a protocol. The team's ability to maintain that standard continuously across both cases was central to the outcome."

Dr Pravir Kumar Das, Head of Department, Cardiac Anaesthesia, BM Birla Heart Hospital, said, "The contribution of our perfusionists, nurses, physician assistants, and medical technologists to these outcomes was as significant as any clinical decision made by the medical team. ECMO of this complexity and duration succeeds only when every member of the team performs at the highest level throughout."

Post-cardiac surgery ECMO is required in approximately 2 to 8 percent of cases. Early initiation and sustained multidisciplinary management determine whether it succeeds. In both Rachel and Sweety's cases, it did.”