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ECMO (Extracorporeal Membrane Oxygenation)

What is extracorporeal membrane oxygenation (ECMO)?

Key points

  1. Extracorporeal membrane oxygenation (ECMO) is a way to provide breathing and heart support. ECMO takes over the work of the heart and lungs.
  2. Doctors place you on ECMO because you have serious, but reversible, heart or lung problems. It is only used in extreme situations.
  3. Without ECMO, the survival rate in such situations is around 20 percent or less. With ECMO, the survival rate can rise to 60 percent.

Extracorporeal membrane oxygenation (ECMO) is a way to provide breathing and heart support. It’s usually used for critically ill infants with heart or lung disorders. ECMO can provide necessary oxygenation to an infant while doctors treat the underlying condition. Older children and adults may also benefit from ECMO under certain circumstances.

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

Who needs ECMO?

purpose

Doctors place you on ECMO because you have serious, but reversible, heart or lung problems. ECMO takes over the work of the heart and lungs. This gives you a chance to recuperate.

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

According to Cincinnati Children’s Hospital, ECMO is necessary only in extreme situations. In general, this is after other supportive measures have been unsuccessful. Without ECMO, the survival rate in such situations is around 20 percent or less. With ECMO, the survival rate can rise to 60 percent.

Infants

For infants, conditions that may require ECMO include:

  • 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

A child might need ECMO if they experience:

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

Adults

In an adult, conditions that might require ECMO include:

  • pneumonia
  • trauma and other emergencies
  • heart support after cardiac failure
  • severe infections

What are the types of ECMO?

 Type 1

ECMO consists of several parts, including:

  • 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 the cannulae return it to the body

During ECMO, the cannulae pump blood that is depleted of oxygen. The membrane oxygenator then puts oxygen into the blood. Then it sends the oxygenated blood through the warmer and filter and returns it to the body.

There are two types of ECMO:

  • veno-venous (VV) ECMO: VV ECMO takes blood from a vein and returns it to a vein. This type of ECMO supports lung function.
  • veno-arterial (VA) ECMO: VA ECMO takes blood from a vein and returns it to an artery. VA ECMO supports both the heart and the lungs. It’s more invasive than VV ECMO. Sometimes the carotid artery (the main artery from the heart to the brain) may need to be closed off afterward.

How do I prepare for ECMO?

Symptoms

A doctor will check an individual before ECMO. A cranial ultrasound will ensure there’s no bleeding in the brain. A cardiac ultrasound will determine whether the heart is working. Also, while on ECMO, you will have a daily chest X-ray.

After determining that ECMO is necessary, doctors will prepare the equipment. A dedicated ECMO team, including a board-certified physician with training and experience in ECMO will do the ECMO. The team also includes:

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

What happens during ECMO?

process

Depending on your age, surgeons will place and secure the cannulae in the neck, groin, or chest while you are under general anesthesia. You will usually remain sedated while you’re on ECMO.

ECMO takes over the function of the heart or lungs. Doctors will perform close monitoring during ECMO by taking X-rays daily and monitoring:

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

A breathing tube and ventilator keep the lungs working and help remove secretions.

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

You can stay on ECMO anywhere from three days to a month. The longer you remain on ECMO, the higher the risk of complications.

What are the complications associated with ECMO?

Complications

The biggest risk from ECMO is bleeding. Heparin thins the blood to prevent clotting. It also increases risk of bleeding in the body and brain. ECMO patients must receive regular screening for bleeding problems.

There’s also a risk of infection from the insertion of the cannulae. People on ECMO will likely receive frequent blood transfusions. These also carry a small risk of infection.

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

What happens after ECMO?

Recovery

As a person improves, doctors will wean them off of ECMO by gradually reducing the amount of blood oxygenated through ECMO. Once an individual gets off ECMO, they’ll remain on the ventilator for a period of time.

Those who have been on ECMO will still need close follow-up for their underlying condition.

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