What you need to know about:

Extracorporeal Membrane Oxygenation (ECMO)

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Overview of

Extracorporeal Membrane Oxygenation (ECMO)

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Extracorporeal membrane oxygenation (ECMO) or extra corporeal membrane life support (ECLS) is a tool that replaces the function of the lungs and heart when they can no longer function normally, even with medication or a ventilator, until the heart and lungs can be treated so they resume normal function. The ECMO acts as an artificial heart/lung which will pump blood instead of the heart and will exchange oxygen instead of the lungs. The ECMO removes blood from the body and moves it through a pump (that functions like the heart) and then it is filtered through a membrane oxygenator that adds oxygen and removes carbon dioxide (functioning like the lungs). The blood is then returned to the body. The mechanism is the same as that of a cardiopulmonary bypass machine. A doctor will place the cannula into a large vein and a large artery at the leg or neck. ECMOs are used in critical care situations when your heart and lungs need all the help they can get so that you may recover.

Goals of

Extracorporeal Membrane Oxygenation (ECMO)

ECMO may be used to help people who are very ill with conditions of the heart and lungs, or who are waiting for or recovering from a heart transplant. It may be an option when other life support measures have not been successful. Although ECMO does not treat or cure your condition, it is very helpful when your body temporarily is unable to provide your tissues with enough oxygen.

The indications for ECMO include:

-Patients who need respiratory support only.

-Patients who need both cardiac and respiratory support, especially in patients with severe problems.

-ECMO may even be indicated while CPR (cardiopulmonary resuscitation) is being carried out.

Some heart conditions in which ECMO may be used include:

-Heart attack (acute myocardial infarction)

-Heart muscle disease (decompensated cardiomyopathy)

-Inflammation of the heart muscle (myocarditis)

-Life-threatening response to infection (sepsis)

-Low body temperature (severe hypothermia)

-Post-transplant complications

-Shock caused by the heart not pumping enough blood (cardiogenic shock)

Some lung (pulmonary) conditions in which ECMO may be used include:

-Acute respiratory distress syndrome (ARDS)

-Blockage in a pulmonary artery in the lungs (pulmonary embolism)

-Coronavirus disease 2019 (COVID-19)

-Defect in the diaphragm (congenital diaphragmatic hernia)

-Fetus inhales waste products in the womb (meconium aspiration)

-Flu (influenza)

-Hantavirus pulmonary syndrome

-High blood pressure in the lungs (pulmonary hypertension)

-Pneumonia

-Respiratory failure

-Trauma

Price of

Extracorporeal Membrane Oxygenation (ECMO)

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Pros and cons of

Extracorporeal Membrane Oxygenation (ECMO)

Pros

-Provides very good cardiopulmonary support

-No mixing of arterial and venous blood

-Good oxygenation at low ECMO flows

-Oxygenated blood returns to patients after arterial circulation

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Cons

-Associated with increased neurological events

-Risks such as infections, bleeding may occur

-Puts most patients in a bedridden position

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How it works:

Extracorporeal Membrane Oxygenation (ECMO)

Your doctor will insert a thin, flexible tube (cannula) into a vein to draw out blood and a second tube into a vein or artery to return warmed blood with oxygen to your body. You will receive other medications, including sedation, to make you comfortable while receiving ECMO, and may not be able to talk during this time. Depending on your condition, ECMO can be used for a few days to a few weeks. The amount of time you receive ECMO depends on your condition. Your doctor will talk with you or your family about what to expect.

The procedure can be done at the patient’s bedside in the Intensive Care Unit (ICU), patient’s ward, or the Emergency Room (ER) in an emergency. In non-emergency situations, the procedure is done in an Operating Room (OR).

The ECMO machine can support a patient until they are through the critical situation or have recovered from their serious injury. If the disease of injury improves, the doctor will slowly reduce the amount of ECMO support. Once the patient is fully improved or remains stable, the ECMO tubes may be removed and a ventilator may be used instead.

Preparation before

Extracorporeal Membrane Oxygenation (ECMO)

Pre - treatment

The doctor will assess the patient to make sure that there is no bleeding in the brain and whether the condition or disease the patient is experiencing can be resolved and the patient can return to normal health. ECMO is usually used when life support is needed after surgery, or when you are very ill and your heart or lungs need help so that you can heal. Your doctor will decide when it may be helpful. If you need ECMO, your doctor and trained respiratory therapists will prepare you.

Recovery after

Extracorporeal Membrane Oxygenation (ECMO)

Post - treatment

The patient’s vital signs will be monitored, including the heart rate, respiratory rate, blood pressure, levels of oxygen and carbon dioxide in the blood, and the circulation. They will also be monitored for any infections or complications.

Risks & side effects

Bleeding, due to the blood thinning medication that is given to prevent blood from clotting in the tubing.

Infection at the insertion sites.

Transfusion problems, since a person on ECMO is given blood products.

Small clots or air bubbles forming in the tubing, in the heart, or in the membrane oxygenator.

Increased chance of stroke if a blood clot forms in the left chamber of the heart.

Some patients on ECMO may experience kidney problems.

Some patients may experience decreased blood flow to the legs, leading to serious leg damage. This complication can be prevented by inserting a small catheter to deliver blood to that leg (distal perfusion).

FAQs:

Extracorporeal Membrane Oxygenation (ECMO)

What are the recommendations for patient transport?

It is not recommended to move a patient on ECMO. If the patient must be moved, they can be moved with an ECMO transport.

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What is the success rate of an ECMO on patient survival?

The success of the ECMO depends on the speed of decision making using ECMO. Information from the Extracorporeal Life Support Organization (ELSO) finds that:

Survival rate for ECMO for the heart is 50%.

Survival rate for ECMO for the respiratory system is 50%.

Survival rate for extracorporeal cardiopulmonary resuscitation (ECPR) is 30%.

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How long is an ECMO machine used?

An ECMO machine can help save a person’s life, but it does not treat the disease or injury that led to the heart and lung failure. An ECMO machine simply provides support for a person while the healthcare team works on treating the underlying disease or injury (such as an infection) or until organs for transplant become available. Healthcare providers will always try to help people get off the ECMO machine as soon as possible. Some diseases or injuries can be treated quickly, and patients only need the ECMO machine for a few hours. Other conditions may take longer to get better, in which case the patient may need the ECMO machine for several days to weeks. Unfortunately, some people do not improve enough to be taken off the ECMO machine. ECMO does not save everyone but it has improved survival for many critically ill people who are not responding to usual life support options.

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How does an ECMO machine work?

The ECMO machine is connected to a patient through plastic tubes (cannula). The tubes are placed in large veins and arteries in the

legs, neck or chest. The procedure by which a healthcare provider places these tubes in a patient is called cannulation. The ECMO machine pumps blood from the patient’s body to an artificial lung (oxygenator) that adds oxygen to it and removes carbon dioxide. Thus, it replaces the function of the person’s own lungs. The ECMO machine then sends the blood back to the patient via a pump with the same force as the heart, replacing its function. The ECMO machine is controlled by a person called a perfusionist, or a nurse or respiratory therapist with advanced training called an ECMO specialist. The perfusionist or ECMO specialist will adjust the settings on the machine to give the patient the amount of heart and lung support they need.

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What does being on ECMO feel like?

When a person is first being connected to an ECMO machine, he or she is sedated and does not feel the tubes going into their veins and arteries. A person on ECMO is usually already connected to a breathing machine through an endotracheal tube that is placed in the mouth or nose and down into the windpipe. People who are on an ECMO machine may be given medicines (sedatives or pain controllers) to keep them comfortable and sleepy. Some people are awake and can talk and interact with people while on an ECMO machine. In some cases, patients can exercise to help build up their strength while they are on an ECMO machine. However, some movements can cause the ECMO tubes to get kinked, so patients need to be assisted and carefully supervised when they are moving.

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