How will ECMO be managed?
Every child on ECMO at ACH has a large team taking care of him/her from beginning to end. This ECMO team is made up of the surgeon, specialized doctors, ECMO specialists, nurses, respiratory therapists, social work, chaplains and any other members of the ACH team that might be involved with direct care. Initially, the surgical and ECMO teams will be called by the patient's doctor, usually a pediatric intensivist, pediatric cardiologist, or a neonatalogist, to place the child on ECMO. The surgeon will place a tube or tubes into the large blood vessels in the neck or the tubes may come out of the chest if the patient has just had heart surgery. The tubes are then connected to the ECMO circuit. The patient's blood drains into the circuit and is circulated up through the artificial lung, where it receives oxygen before returning back to the patient.
There are two types of ECMO support depending on the patient's medical condition. Veno-arterial ECMO (VA ECMO) is used when the patient requires assistance for both the heart and the lungs. The blood is drained from a very large vein and then returned to the body through a large artery after oxygen has been added to the blood. This process takes most of the workload off both the child's heart and the child's lungs, providing support to vital organs and tissue. Veno-venous ECMO (VV ECMO) is used primarily when the lungs have failed but the heart is still working fairly well. The blood is drained from a large vein and is returned with oxygen through the same vein. Both types of ECMO provide efficient oxygenated blood to organs and the body tissues.
During ECMO when efficient flow is established to your child the ventilator will be adjusted to settings that allow the lungs to rest. The breathing machine settings remain at rest until your child is ready to come off ECMO. The lungs and/or heart may take days to weeks to heal and this time varies based upon the child's illness. As your child improves, the ECMO flow will be turned down (weaned) and the lungs and/or heart will do more of the work.
Your child will be continuously monitored on ECMO while in the intensive care area. Labs will be drawn often to help manage the ECMO pump and your child's medical treatments. X-rays will be done daily to review lung condition. For baby's, an ultrasound of the head will be done regularly to check for bleeding that can occur in the head. Transfusions of blood products are required to keep your child's blood counts normal. These products are given routinely to assist your child with clotting and to help oxygenate. As before ECMO, your child will continue to receive intensive nursing care while on ECMO. Your child will be receiving a drug called heparin which helps to prevent clotting in the ECMO circuit. The ECMO specialists will perform a blood test called the ACT (activated clotting time) very frequently while your child is on ECMO. The ACT test helps us make adjustments to how much blood-thinner medicine is needed.