Extracorporeal Membrane Oxygenation (ECMO)
Explanation | Reason for ECMO | The Procedure | Risks | Preparation | Success Rate
What is extracorporeal membrane oxygenation (ECMO)?
Extracorporeal membrane oxygenation (ECMO) is an important treatment for infants and children with cardiorespiratory failure.
Extracorporeal Membrane Oxygenation is the use of an artificial lung (membrane) located outside the body (extracorporeal), that puts oxygen into the blood and then carries this blood to the body tissues (oxygenation).
It is a modified form of heart-lung bypass and is used for a longer period than the machines used in the operating room during open-heart surgery.
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Why would extracorporeal membrane oxygenation be recommended?
Extracorporeal membrane oxygenation can take over the function of the child's heart and / or lungs for a limited time until the child recovers from the initial cause of the failure.
The most frequent use for ECMO has been with newborn respiratory failure, although it may also be helpful in selected cases of severe heart failure in infants and children.
There are several instances when the heart may need extra support. One use is soon after heart surgery to allow the heart to recover from surgery.
Another use is as a "bridge" to heart transplant where extracorporeal membrane oxygenation can continue to support the child until a heart becomes available.
It can also be used to provide support for a child waiting for cardiac surgery.
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How is extracorporeal membrane oxygenation done?
Extracorporeal membrane oxygenation may be initiated in the operating room immediately after an operation, or in the intensive care unit (ICU).
When initiated in the operating room, the tubes connecting the patient to the extracorporeal membrane oxygenation circuit are generally placed directly into the large blood vessels adjacent to the heart, similar to the connections made during open heart surgery.
When extracorporeal membrane oxygenation is begun in the intensive care unit, the tubes are usually placed via blood vessels at the base of the neck. This procedure can take place at the bedside in the intensive care unit.
Typically, a small incision is made along the right side of the neck. One cannula is placed in a large vein in the neck leading to the right atrium of the heart.
Another cannula is placed in a large artery (carotid artery). The cannulas are then connected to the tubing of the extracorporeal membrane oxygenation machine and bypass circulation is begun.
Blood drains from the right side of the heart through the venous tubing and is pumped through the membrane oxygenator (artificial lung), which takes over the work of the baby's lungs. The blood is then rewarmed and returned to the body through the arterial cannula.
This oxygen-enriched blood is carried throughout the body, supplying the brain, heart, kidneys, and all other vital organs and tissues.
As the heart improves, the amount of blood flow through the extracorporeal membrane oxygenation circuit can be decreased, allowing the heart to do more of the work.
Who orders or performs extracorporeal membrane oxygenation?
The doctors who have been caring for the child will decide if extracorporeal membrane oxygenation is needed. They will discuss this with you, as well as the extracorporeal membrane oxygenation physicians.
Is extracorporeal membrane oxygenation painful or uncomfortable?
When placing the cannulas, a local anesthetic is used at the site as well as strong anesthetic medicines given through an IV.
Once on extracorporeal membrane oxygenation, children may be allowed to wake up and interact. This allows caregivers the ability to monitor neurologic status. If the child becomes restless, more medicine for pain and relaxation will be given.
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What are the risks or possible complications of the treatment?
While on extracorporeal membrane oxygenation, a medicine called heparin is given. This is a medicine to help prevent clots from forming in the artificial tubing.
Bleeding complications are the most commonly seen with extracorporeal membrane oxygenation support. Bleeding from the surgical site may occur.
Another complication that may occur is an intraventricular hemorrhage (IVH). This is when there is bleeding into the brain. For newborns and infants, periodic head ultrasounds are done to monitor for intraventricular hemorrhage.
Infections, renal failure and failure of the heart to recover adequately are other problems that may be seen during extracorporeal membrane oxygenation support.
Generally, the risk of complications increases with the duration of time on ECMO.
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Is there any special preparation for extracorporeal membrane oxygenation?
Once the decision has been made to place the child on ECMO, the extracorporeal membrane oxygenation team needs to be notified. This team is responsible for preparing the equipment for the child.
Blood products are ordered and are used to prepare the extracorporeal membrane oxygenation tubing that will be connected to the child.
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Extracorporeal membrane oxygenation success
Extracorporeal membrane oxygenation is typically reserved as an extreme supportive measure when more conventional measures have failed.
Survival in such situations is often felt to be 20 percent or less. With extracorporeal membrane oxygenation, survival in these situations is reported to improve to between 20 percent to 60 percent depending on the specific circumstances. Most post open-heart surgery patients who require ECMO are supported for approximately 3 to 4 days, but ECMO can be continued up to two to three weeks, if indicated. Cardiac function is evaluated on a daily basis (based on clinical course, blood tests, and postoperative echocardiograms) to determine whether a patient is ready to be "weaned" from ECMO.
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Revised 9/06