What is Extracorporeal Membrane Oxygenation?

ecmo, Extracorporeal Membrane Oxygenation, ecmo machine, Extracorporeal Membrane Oxygenation machineSimilar to the heart-lung bypass machine used in open heart surgery, extracorporeal membrane oxygenation (ECMO) is an advanced life-support device that pumps and oxygenates a patient’s blood outside the body, permitting the heart and lungs to rest. When connected to the ECMO machine, your blood flows through tubing to an artificial lung inside the machine that adds oxygen and removes carbon dioxide. The blood is then warmed to your body temperature and pumped back into your body.

ECMO machines have been around since 1970s, and are often associated with infants in respiratory distress. ECMO is not a routinely prescribed procedure. It’s only used when all other life-saving options have been exhausted.

Types of ECMO

There are two types of ECMO machines:

  1. Veno-arterial (VA) ECMO – this type of ECMO machine connects to both a vein and an artery. It’s used when there are difficulties with both the heart and the lungs.
  2. Veno-venous (VV) ECMO – this type of ECMO machine connects to one or more veins that are usually close to the heart. It’s used when the trouble is only in the lungs.

Small, ultra-light portable ECMO machines are available that can be carried by one person in the event of an emergency. These machines are light enough to be transported in an ambulance or helicopter and have the ability to save more lives in emergency situations.

When is ECMO Used?

ECMO is used in the following situations:

  • In patients recovering from heart failure, respiratory failure or heart surgery.
  • For support during high risk procedures in the cardiac catheterization lab.
  • To assess the state of other organs – like the brain or kidneys – before carrying out heart or lung surgery.
  • For patients awaiting lung transplant, ECMO helps maintain tissue oxygenation, which improves the chances of being a candidate for a successful transplant.
  • As a bridge to patients with heart failure who are waiting for heart transplantation or placement of a ventricular assist device, a long-term circulatory support device.

What’s the Procedure Like?

Both initiating and discontinuing ECMO requires a surgical procedure that can be done at the bedside in a patient’s room. You’ll be given sedation and an anticoagulant to help prevent your blood from clotting. A surgeon will insert the ECMO catheters into either veins or an artery with the help of other surgical team members. Tube placement will then be verified with an X-ray.

Most patients on ECMO are also on an artificial breathing machine called a ventilator. This machine helps your lungs heal properly. While on ECMO, specially trained nurses and respiratory therapists will monitor you frequently, along with your surgeon and surgical team. Because you’ll be sedated and on a ventilator, supplemental nutrition will be provided either intravenously or through a naso-gastric tube (a tube that’s inserted through the nose that goes down into the stomach). While on ECMO, you may receive any of the following medications:

  • Heparin to prevent blood clots.
  • Antibiotics to prevent infections.
  • Sedatives to minimize movement and improve sleep.
  • Diuretics to help remove excess fluid.
  • Electrolytes to maintain the balance of salt and sugars in your body.
  • Blood products to replace any loss of blood.

What are the Risks Involved?

As with any surgical procedure ECMO does involve certain risks including:

  • Bleeding – a possible side effect of anticoagulant medications.
  • Infection – at the surgical sites where the tubes are place.
  • Blood transfusion issues – associated with receiving blood products.
  • Small clots or air bubbles – may form in the tubing.
  • Increased risk of stroke – associated with hypertension.

For more information about extracorporeal membrane oxygenation, talk to your heart or lung specialist. 

Source:

UCSF Department of Surgery. Extracorporeal Membrane Oxygenation. Accessed February 2, 2018.

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