From Guayaquil to Bucaramanga: Ricardo’s story and the hope he found in Colombia

• An Ecuadorian baby just a month and a half old overcame a severe respiratory infection thanks to a high-complexity therapy and the coordinated work of medical teams from Ecuador and Colombia. His story highlights how international collaboration and timely access to specialized technology can save lives.
• Extracorporeal membrane oxygenation (ECMO) is a therapy that temporarily replaces the functions of the heart and lungs, allowing these organs to rest while the body recovers. Since this therapy is not available for pediatric patients in Ecuador, a team from the Hospital Internacional de Colombia (HIC) traveled to Guayaquil, initiated ECMO support, and successfully transferred the baby to Bucaramanga. The procedure, considered one of the most complex in intensive care medicine, was carried out successfully thanks to the team's training and experience.
• After ECMO support was initiated, the patient developed complications commonly seen in these cases, which were identified and managed in a timely manner through close clinical monitoring. After nearly two months of hospitalization, he was discharged in stable condition and without major sequelae.

Bucaramanga, Colombia, May 2025. Ricardo Luque was born in Guayaquil, Ecuador, at 36 weeks of gestation—a late prematurity that increased his vulnerability to respiratory infections. At just 52 days old—approximately a month and a half—he began to show symptoms that quickly worsened. The diagnosis was acute bronchiolitis caused by respiratory syncytial virus (RSV), the leading cause of this disease in infants.

Although often mild, RSV infections can be fatal in the youngest patients. According to a 2022 study published in The Lancet, RSV accounted for 2% of all deaths in children under five and 3.6% of deaths in infants aged 28 days to six months. Moreover, 95% of lower respiratory tract infections and over 97% of RSV-related deaths occurred in low- and middle-income countries.

Initially, Ricardo received supplemental oxygen, but within hours his condition deteriorated into severe respiratory failure requiring invasive mechanical ventilation. Despite the medical team's efforts, his body was unable to adequately oxygenate or eliminate accumulated gases. The viral infection was further complicated by a bacterial superinfection, which is common in such cases, and by acute myocarditis—an inflammation of the heart—along with arrhythmias and elevated cardiac markers.

Faced with progressive clinical decline, the only viable alternative was to initiate extracorporeal membrane oxygenation (ECMO), a high-complexity therapy that temporarily replaces pulmonary and cardiac function. Since this technology is not available for pediatric patients in Ecuador, the family began searching for alternatives abroad.

“From the very beginning, our intention was to transfer him. We thought of the United States, but they told us he wouldn’t survive the trip unless he had an ambulance plane equipped with ECMO. That’s when our international insurance, Best Doctors, recommended the Hospital Internacional de Colombia (HIC) in Bucaramanga. We heard great things about the hospital and decided to trust them,” says Cristina Coronel, the baby’s mother.

Once the case was accepted, the HIC Cardiovascular Institute activated its ECMO team and established contact with the treating physicians in Guayaquil. At that point, Ricardo was already intubated and on mechanical ventilation. Although his oxygen levels were relatively stable, he was retaining a significant amount of carbon dioxide—an indicator of progressive ventilatory failure. Over 48 hours, the Colombian team reviewed his blood gases, X-rays, and lab results, confirming the urgent need for intervention. The decision was made to send a medical team from Bucaramanga to assess him on-site.

“When we arrived at the intensive care unit in Guayaquil, Ricardo seemed stable. But when we connected him to our ventilator, we saw that he couldn’t tolerate even minimal changes, and his CO₂ levels spiked quickly. It was clear he wouldn’t survive the transfer without ECMO,” explains Dr. Angélica Lucero Ortiz, a pediatric intensive care specialist with advanced training in extracorporeal membrane oxygenation and mechanical circulatory support.

After discussing the risks and benefits with the parents, the team initiated ECMO therapy in Guayaquil and organized the air transfer. Transporting a pediatric patient on ECMO is one of the most complex procedures in critical care due to the need to maintain stable perfusion and oxygenation throughout the flight. Thanks to the Colombian team’s expertise, the transfer was completed successfully.

Once in Bucaramanga, Ricardo was admitted to the Pediatric Intensive Care Unit at the hospital. There, an interdisciplinary team began the stabilization process. While ECMO does not directly cure the underlying pulmonary condition, it allows the lungs to rest and recover from the damage caused by prolonged mechanical ventilation. In Ricardo’s case, the therapy enabled a reduction in ventilator settings, progressive improvement in oxygenation and CO₂ clearance, and radiographic evidence of pulmonary recovery.

“In this case, the coordinated work between physicians, nurses, respiratory therapists, and other specialists allowed us to remove ECMO support by the fifth day. That’s a short and very favorable timeframe for this type of patient,” notes Dr. Ortiz.

Although Ricardo’s progress was positive from the outset, his recovery involved overcoming common challenges in ECMO patients. “He developed a bacterial superinfection—seen in about 18% of cases—and a coagulopathy that required frequent transfusions and ongoing hematologic monitoring,” explains Dr. Ortiz. Thanks to strict clinical surveillance, these conditions were managed promptly, preventing serious complications such as cerebral hemorrhage, one of the most feared outcomes of this therapy.

“Those were incredibly hard days. We lived in constant uncertainty, but what kept us going was the humanity of the team. We felt like Ricardo was their most important patient, but then we realized they gave that same dedication to every child. The care was impeccable in every way,” says Cristina, recalling their experience in Bucaramanga.

Ricardo was discharged after nearly two months of specialized care and returned to Ecuador with his parents. During their time in Colombia, the family received logistical and emotional support from the HIC International Office, which coordinated accommodations, kept them in constant contact with the care team, and provided guidance throughout every stage of the process.

Today, Ricardo is stable and growing alongside his family. His case represents a story of life that connects two countries and demonstrates what modern medicine and collaborative effort can achieve.

“Sometimes, the most important thing is knowing you’re not alone. In Bucaramanga, we felt that from the very beginning,” concludes Cristina.

A leader in ECMO support

The ECMO unit at the HIC Cardiovascular Institute was one of the first in Latin America. It began operations in 2007 with a capacity for four patients and, following the pandemic, expanded to 24 simultaneous ECMO stations. The center now has dedicated teams trained in critical care transport and advanced life support for both adult and pediatric patients.

In the past year alone, the institution has received approximately 50 international patients, including two pediatric ECMO cases, both of which resulted in successful outcomes. Beyond survival, the team's focus is on achieving full recovery so that each patient can return to their family with quality of life.