oa SWAC ELSO: Past, present and future

The South and West Asia Chapter of Extracorporeal Life Support Organisation (SWAC ELSO) was established in the year 2013 with the combined efforts of senior members from the ELSO and the ECMO society of India.¹ It was established with the idea of improving the awareness and practice of ECMO in this part of the world. I am pleased to see the growth of the organisation in the next couple of years. This region is representative of the member countries from the SAARC (South Asian Association for Regional Cooperation) and Gulf region. In 2016, South Africa joined the chapter.

The population of the SWAC ELSO region is 2.56 billion, which is one-third of the world's population.² South Asia, West Asia and Africa are unique with respect to the challenges offered to the healthcare delivery. There are wide variations in the economic potential of the countries. Healthcare inequalities do exist. ECMO is an intervention which is likely to bring the patient back to life in reversible cases of cardiorespiratory failure, when it is initiated at the right time. It does not come free of cost. Optimisation of the healthcare cost remains a priority. More efforts need to be put in this direction of developing a cost-effective model of ECMO.

Though I appreciate the way ECLS is provided in much of the developed world, there must be innovative ways to practice the science with the same principles in the resource-limited countries. Quality is very important and must be maintained. Collectively, similar-minded individuals with entrepreneurship should be able to develop a model of ECMO for resource-limited parts of the world. Infection is a main deterrent in achieving the optimal results globally.³ By adopting antibiotic stewardship principles and self-governance, infection can be brought under control. We do not need new antibiotics to achieve this goal.

The indications for ECMO have been varying in this part of the world. Though ARDS (adult respiratory distress syndrome) secondary to viral and bacterial pneumonias remains the predominant cause⁴ to seek support from ECMO, myocarditis due to scorpion stings, snake bites, supporting patients post poisoning like organo-phosphorous poisoning, celphos poisoning and exposure to various other poisons are some of the other examples. ARDS secondary to malaria, tuberculosis and other newer varieties of viral pneumonias (SARS, H1NI, H5N1, Dengue, etc.) offers exciting opportunities for application of this life-saving modality. Controlling drug-resistant infections is a major challenge and a priority. There are other challenges like lack of ideal transport facilities to cover long distances effectively. Cardiac ECMO as extended cardiopulmonary bypass is practised much more widely than respiratory ECMO.

The past has seen the development and standardisation of ECMO. We have been seeing the implications for solving the healthcare needs of mankind using ECLS (extracorporeal life support). With united efforts and mutual co-operation, we should make progress and help each other in unleashing the obstacles preventing the growth potential of ECLS. Life is a God-given gift. Let us join hands and save more lives. Let us show the unity in diversity.