When All Seems Lost, Hope Remains: IJN’s Life-Saving ECMO Care

KUALA LUMPUR, Dec 23 (Bernama) -- When a medical emergency reached its most critical point and standard treatments had failed, hope could feel distant. Yet, at Institut Jantung Negara (IJN), those moments were often where the fight for recovery truly began.

In advanced cardiac and respiratory care, the most defining decisions were made in intensive care units (ICUs), where patients arrived with rapidly failing hearts, lungs and other vital organs.

At this stage, survival no longer depends on routine treatment alone, but on swift clinical judgement, experience and the ability to act decisively within a narrow window.

One of the most complex and high-risk interventions used by IJN in such situations was Extracorporeal Membrane Oxygenation (ECMO), a portable system that temporarily took over the work of the heart and lungs, allowing critically ill organs time to rest and recover.

According to IJN chief executive officer Prof Datuk Seri Dr Mohamed Ezani Md Taib, ECMO was not simply a machine that was switched on, as its success depended on constant monitoring, precise adjustments and continuous reassessment by a highly specialised multidisciplinary team working around the clock.

He said managing ECMO patients required particularly careful judgement, especially when withdrawing support, as removing the device was more complex than its insertion.

This involved a gradual reduction of support and the use of ultrasound to confirm that the heart could function independently.

“Sometimes, when patients arrive very sick, and options are limited, that is when IJN can step in. ECMO gives the heart a chance to rest and recover. We will not give up if there is still a possibility to save a life,” he told reporters in a special press conference recently.

Dr Mohamed Ezani explained that ECMO patients require constant, round-the-clock attention from teams that include cardiologists, cardiac surgeons, intensivists, anaesthesiologists, perfusionists and critical care nurses, as even small changes in blood flow or medication can have major consequences.

For instance, he said the medical institute recently treated an international student from China who, after a viral fever, rapidly progressed into acute heart failure, arrived in cardiogenic shock and later required ventilator support when his condition deteriorated elsewhere despite treatment.

One by one, other organs, including his kidneys and liver, began to fail. By the time he was referred to IJN, conventional therapies and multiple medications were no longer enough.

“After careful assessment and discussion, the ICU team decided to initiate ECMO support, where the intervention allowed his heart to rest while blood circulation and oxygen delivery to his body were stabilised,” Dr Mohamed Ezani said. 

He said the first days were critical, but gradually, the patient's blood pressure stabilised, medication doses were reduced, and early signs of heart recovery began to emerge, with the team then using continuous reassessment and imaging, including ultrasound, to monitor whether his heart could once again function on its own.

“The ECMO support was carefully reduced and withdrawn as his heart recovered. The patient was later weaned off the ventilator, began rehabilitation and slowly regained strength before preparing to return home,” he said.

In another case, Dr Mohamed Ezani said IJN also cared for a young Malaysian woman who developed acute heart failure after childbirth, a condition known as postpartum cardiomyopathy.

“She was transferred to IJN and placed on ECMO support. Her case was especially challenging as she remained critically ill for several days before signs of improvement finally appeared,” he noted.

After 11 days, Dr Mohamed Ezani said ECMO support was successfully withdrawn, and the woman later recovered sufficiently to reunite with her newborn child.

As Malaysia’s national cardiac referral centre, IJN routinely received patients from both government and private hospitals when conventional therapies were no longer effective, maintaining that hope persisted as long as there was a possibility to save a life.

-- BERNAMA