ECMO (Extracorporeal Membrane Oxygenation)

Written by Danielle Moores | Published on June 22, 2012
Medically Reviewed by George Krucik, MD

What is ECMO?

Extracorporeal membrane oxygenation (ECMO) helps support the heart and/or lungs. It is most often used for critically ill infants with heart or lung disorders. Children and adults may also benefit from ECMO.

ECMO uses a type of artificial lung to oxygenate the blood. This device is called a membrane oxygenator. It combines with a warmer and a filter to supply oxygen to the blood and return it to the body.

According to the Extracorporeal Life Support Organization, ECMO was first used in 1975. Annually, 2,800 newborns benefit from ECMO. The use of ECMO in children and adults is increasing (ELSO, 2010 ).

Who Needs ECMO?

Patients are placed on ECMO because they have very serious, but potentially reversible heart and lung problems. ECMO takes over the work of the heart and lungs. This gives patients a chance to rest and recuperate.

ECMO can give the tiny hearts and lungs of newborns more time to develop. ECMO may also be used as a “bridge” before and after treatments like heart surgery.

According to Cincinnati Children’s Hospital, ECMO is typically used in extreme situations. In general, this is after other supportive measures have failed. Patients’ survival in such situations is usually estimated at 20 percent or less. With ECMO, survival rates can rise to 60 percent (Cincinnati Children’s, 2010 ).

Conditions that may require ECMO include:

Infants

  • respiratory distress syndrome (difficulty breathing)
  • congenital diaphragmatic hernia (a hole in the diaphragm)
  • meconium aspiration syndrome (inhalation of waste products)
  • pulmonary hypertension (high blood pressure in the pulmonary artery)
  • severe pneumonia
  • respiratory failure
  • cardiac arrest
  • cardiac surgery
  • sepsis

Children

  • pneumonia
  • severe infections
  • congenital heart defects
  • cardiac surgery
  • trauma and other emergencies
  • aspiration of toxic materials into the lungs
  • asthma

Adults

  • pneumonia
  • trauma and other emergencies
  • heart support
  • severe infections

How Does ECMO Work?

ECMO consists of several parts:

  • cannulae: large catheters (tubes) inserted into the blood vessels to remove and return blood
  • membrane oxygenator: an artificial lung that oxygenates the blood
  • warmer and filter: machinery that warms and filters the blood before it is returned

During ECMO, the cannulae pump “blue” blood from the body. This is blood that has been depleted of oxygen. The membrane oxygenator puts oxygen into the blood. This turns it red. This blood is then sent through the warmer and filter and returned to the body.

There are two types of ECMO:

VV ECMO

Veno-venous (VV) ECMO takes blood from a vein and returns it to a vein. It is used to support lung function.

VA ECMO

Veno-arterial (VA) ECMO takes blood from a vein and returns it to an artery. VA ECMO supports both the heart and the lungs. It is more invasive than VV ECMO. Sometimes the carotid artery may need to be closed off afterwards. The carotid artery is the main artery from the heart to the brain.

Preparing for ECMO

The patient will be evaluated prior to ECMO. A cranial ultrasound will make sure there is no bleeding in the brain. A cardiac ultrasound will determine whether the heart is working normally.

While on ECMO, the patient will have a daily chest X-ray.

Once a decision has been made to start ECMO, the equipment will be prepared. This is done by a dedicated ECMO team, including a board-certified physician with training and experience in ECMO. It also includes:

  • ICU registered nurses
  • respiratory therapists
  • perfusionists, who specialize in the use of heart-lung machines
  • support personnel and consultants
  • a 24/7 transport team
  • rehab specialists

ECMO physicians may have board certification in:

  • neonatology
  • critical care
  • cardiovascular/thoracic care
  • other specialties

What Happens When a Patient Goes on ECMO?

Depending on the age of the patient, surgeons will place and secure the cannulae in the neck, groin, or chest. This is completed under general anesthesia. The patient usually remains sedated while he or she is on ECMO.

ECMO takes over the function of the heart and/or lungs. While a patient is on ECMO, they need close monitoring. This may include taking X-rays daily and monitoring:

  • heart rate
  • respiratory rate
  • oxygen levels
  • blood pressure

A breathing tube and ventilator will be used. This keeps the patient’s lungs working and helps remove secretions.

Medications will be provided continuously through intravenous catheters. One important medication is heparin. This blood thinner prevents clotting as blood travels within the ECMO.

Patients can stay on ECMO anywhere from three days to a month. However, the longer a patient remains on ECMO, the higher the risk of complications.

What Risks and Potentially Complications Are Involved?

The biggest risk from ECMO is bleeding. Heparin thins the blood to prevent clotting. However, it also increases risk of bleeding in the body and brain. ECMO patients must be regularly screened for bleeding problems.

There is also a risk of infection from the insertion of the cannulae. Patients will likely receive frequent blood transfusions during ECMO. These also carry a small risk of infection.

Malfunction or failure of ECMO equipment is another risk. The ECMO team is trained to act in emergency situations like ECMO failure.

Following Up and Recovering After ECMO

As patients improve, they will be weaned from ECMO. This is done by gradually reducing the amount of blood oxygenated through ECMO. Once patients get off ECMO, they will typically remain on the ventilator for a period of time.

Patients who have been on ECMO will still need close follow-up for the underlying condition. In addition, infants with low oxygen levels prior to ECMO are at higher risk for developmental problems.

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