Pulmonary Rehabilitation

ECMO (Extracorporeal Membrane Oxygenation) Support ECMO (Extracorporeal Membrane Oxygenation) is a life-saving, advanced form of heart-lung support used for critically ill patients whose lungs or heart are failing despite maximum medical and ventilator therapy. At our center, under the leadership of Dr. Shubham Sharma, ECMO is used as part of a comprehensive strategy in managing severe respiratory failure, cardiopulmonary collapse, and as a bridge to lung transplantation. What Is ECMO? ECMO is a machine that temporarily takes over the function of the lungs—and in some cases, the heart—by oxygenating the blood outside the body and removing carbon dioxide. It allows the lungs (and heart) time to rest and heal or serves as a bridge until further treatment such as lung transplant becomes possible. Types of ECMO VV-ECMO (Veno-Venous) Supports only the lungs. Used in conditions like: ARDS (Acute Respiratory Distress Syndrome) Severe pneumonia Post-COVID lung failure Interstitial lung disease with acute exacerbation Bridge to lung transplant VA-ECMO (Veno-Arterial) Supports both the heart and lungs. Used in: Cardiogenic shock Cardiac arrest Severe combined cardiac and respiratory failure When Is ECMO Used? ECMO is considered when conventional treatment options like mechanical ventilation or medications fail to maintain adequate oxygenation or circulation. Indications include: Severe ARDS unresponsive to ventilator support Life-threatening hypoxemia or hypercapnia Lung injury due to infection, trauma, or inhalation injury Bridge to recovery or transplantation Cardiopulmonary resuscitation (ECPR) ECMO Services at Our Center Bedside ECMO initiation in ICU or emergency 24/7 ECMO team including pulmonologists, intensivists, cardiac surgeons, perfusionists, and critical care nurses Mobile ECMO retrieval and transport from peripheral hospitals (in select cases) Multidisciplinary care including physiotherapy, nutrition, and infection control Bridge-to-Transplant ECMO support for patients awaiting lung transplantation Weaning and rehabilitation protocols for optimal recovery Expertise That Matters Dr. Shubham Sharma brings extensive experience in managing ECMO cases, with international training in advanced lung failure and transplant medicine from the Medical University of Vienna. His team is adept at timely ECMO initiation, precise monitoring, and individualized weaning strategies, ensuring that patients receive the best chance at recovery or safe transition to transplant. Frequently Asked Questions Is ECMO a cure? No. ECMO is not a cure but a supportive therapy—it buys time for the lungs or heart to recover or for definitive treatments like a transplant. How long can someone stay on ECMO? Duration varies but typically ranges from a few days to several weeks, depending on the underlying condition and recovery. Is ECMO risky? While lifesaving, ECMO is a complex procedure with risks like bleeding, infection, and clotting. Expert management and continuous monitoring are critical.

Advanced Lung Failure Management Advanced lung failure refers to the final stages of chronic or acute lung disease where the lungs can no longer perform their essential functions—even with maximal medical therapy. Managing such complex cases requires timely intervention, cutting-edge technology, and a multidisciplinary approach. Under the leadership of Dr. Shubham Sharma, our program offers a comprehensive pathway to manage patients with advanced respiratory failure, including those being considered for lung transplantation or ECMO (Extracorporeal Membrane Oxygenation) support. Conditions We Treat We specialize in managing patients with severe or end-stage: Interstitial Lung Disease (ILD) / Pulmonary Fibrosis Chronic Obstructive Pulmonary Disease (COPD) Cystic Fibrosis Pulmonary Hypertension Bronchiectasis Post-COVID Fibrosis Acute Respiratory Distress Syndrome (ARDS) Refractory Asthma or Hypoventilation Syndromes Our Advanced Lung Failure Services 1. Comprehensive Evaluation We assess the severity and trajectory of lung disease using high-resolution imaging, lung function tests, exercise testing, echocardiography, and right heart catheterization. 2. Advanced Respiratory Support Including: High-Flow Nasal Oxygen (HFNO) Non-Invasive Ventilation (NIV) Invasive Mechanical Ventilation ECMO (VA/ VV ECMO): For patients with life-threatening respiratory failure, ECMO provides temporary support, buying time for recovery or transplant. 3. Optimization of Medical Therapy Personalized pharmacological management including antifibrotics, biologics, bronchodilators, steroids, pulmonary vasodilators, and antibiotics. 4. Bridge to Lung Transplant For eligible patients, we offer a structured pathway to lung transplantation, including transplant listing, prehabilitation, and donor matching. 5. Multidisciplinary Care Team Our unit works closely with specialists in critical care, cardiology, thoracic surgery, physiotherapy, nutrition, and infectious diseases to ensure all aspects of care are addressed. 6. Rehabilitation and Recovery Customized pulmonary rehabilitation programs improve strength, breathing efficiency, and quality of life—even in advanced disease stages. 7. Palliative and Supportive Care For patients not eligible for transplant or ECMO, we ensure comfort-focused care, symptom management, and end-of-life planning with dignity and empathy. Why Our Program Stands Out Dr. Sharma’s expertise in lung transplant medicine, ECMO management, and interventional pulmonology makes our center one of the few in India offering comprehensive advanced lung failure services. With global training and hands-on experience in complex respiratory care, we are committed to offering hope and high-quality care to even the sickest patients. We don’t give up—until every option has been explored.

Pre- and Post-Lung Transplant Care Lung transplantation is a life-saving option for patients with end-stage lung disease. At the heart of successful outcomes lies not just the surgery itself—but comprehensive care before and after the transplant. Dr. Shubham Sharma and his team offer a structured, evidence-based approach to ensure the best possible outcomes for each patient. Pre-Transplant Care Preparing for a lung transplant involves more than just waiting for a donor. It is a critical phase focused on optimizing your health, evaluating suitability, and preparing physically and mentally for the journey ahead. Our Pre-Transplant Services Include: Detailed Evaluation: Comprehensive assessment of lung function, heart health, nutrition, infections, and other organ systems. Diagnostic Testing: Includes blood work, imaging (HRCT, PET-CT), 6-minute walk test, echocardiography, right heart catheterization, and psychosocial evaluation. Optimization of Medical Therapy: Fine-tuning current medications and non-invasive ventilation support to stabilize your condition. Rehabilitation & Nutrition: Supervised pulmonary rehabilitation and nutritional counseling to build strength ahead of surgery. Vaccinations & Infection Control: Ensuring immunization is up to date and ruling out latent infections (e.g., TB, CMV). Education & Counseling: One-on-one sessions for patients and families to understand the transplant process, risks, and lifelong care needs. Listing & Coordination: Guidance through the transplant registration and donor-matching process via national transplant registries. Post-Transplant Care Post-operative care is a long-term commitment. The goal is to protect the new lung, prevent complications, and enable a return to normal life. Key Components of Post-Transplant Care: Immunosuppressive Therapy Management: Tailored medication regimens to prevent rejection while minimizing side effects. Infection Surveillance: Regular monitoring for bacterial, viral, and fungal infections—especially during the first 12 months. Rejection Monitoring: Bronchoscopies, imaging, and lung function tests are done periodically to detect early signs of rejection. Rehabilitation & Recovery: Continued physiotherapy and exercise programs to rebuild stamina and function. Nutritional Support & Lifestyle Counseling: Ongoing dietary planning, smoking cessation (if applicable), and psychological support. Regular Follow-Ups: Structured follow-up visits, lab testing, and multidisciplinary support for long-term health and graft survival. Patient Education: Empowering patients with knowledge to recognize warning signs, adhere to medications, and maintain hygiene and lifestyle adjustments. Why Choose Us? Dr. Shubham Sharma brings deep expertise in lung transplantation, including international training from the Medical University of Vienna, and has played a central role in launching transplant programs in India. His team is dedicated to delivering personalized, compassionate, and state-of-the-art care at every stage of the transplant journey. We don't just perform transplants—we help you reclaim your life

Lung transplantation is a life-saving option for patients with end-stage lung diseases when all other treatments fail. Two primary surgical approaches exist—single-lung transplantation (SLT) and double-lung transplantation (DLT)—each with unique benefits, risks, and outcomes. Who benefits from which procedure? SLT is often considered for patients with localized conditions such as idiopathic pulmonary fibrosis (IPF) or in older patients where a shorter, less invasive surgery reduces immediate risks. In contrast, DLT is recommended for conditions involving both lungs, such as cystic fibrosis, pulmonary hypertension, and advanced emphysema, where replacing both lungs ensures better function and safety. Survival and outcomes Registry data suggest that DLT generally offers longer survival, with a median of 6.6–6.7 years compared to 4.6 years for SLT. In IPF, DLT provides clear advantages, with higher long-term survival rates—55% at 10 years versus 32% for SLT. For COPD, the survival difference is smaller, and in some cases SLT on the right lung yields comparable results. For pulmonary hypertension and cystic fibrosis, however, DLT delivers significantly superior survival, with studies reporting 5-year survival of 84% versus 51%. Functional recovery DLT recipients often experience greater improvements in lung function and exercise tolerance. Research shows longer six-minute walk distances and stronger lung volumes compared with SLT, translating into better quality of life. Advancements in techniques Recent milestones include the world’s first fully robotic DLT using the da Vinci Xi system, which reduced recovery burden, and the growing use of ex-vivo lung perfusion (EVLP) to recondition donor lungs once considered unsuitable. EVLP protocols can extend lung preservation up to 17 hours, improving donor availability and transplant outcomes. Surgical considerations SLT is shorter, less complex, and often chosen for patients at higher surgical risk. DLT, performed through clamshell or bilateral thoracotomy incisions, is more demanding but often delivers better long-term benefits. In summary, DLT is generally superior for patients with diffuse or bilateral disease, offering longer survival and better functional recovery. SLT remains valuable in select cases—particularly older patients or those with unilateral disease. With advances in surgical robotics and organ preservation, both approaches continue to evolve, bringing new hope to patients facing otherwise untreatable lung failure.