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What is ECMO?
What is ECMO? ECMO (Extracorporeal Membrane Oxygenation) is a method for temporarily
supporting patients with severe heart and/or lung failure. The ECMO circuit
essentially adds oxygen to the blood and can help the heart pump blood to the
body. Basically, it is similar to a heart-lung bypass machine used during open
heart surgery but can be used for a longer treatment period. ECMO uses
an artificial lung called a membrane. Blood is pumped through this lung by
the machine where carbon dioxide is removed and oxygen is added. This enables
the patient’s doctors to use lower settings on the ventilator (breathing
machine), hopefully allowing the patient’s lungs to “rest” and
heal. Since blood is circulated outside the body (extracorporeal) and loses
heat, the oxygenated blood passes through a heat exchanger warming it prior
to returning to the patient. The ECMO pump can provide cardiac support by taking
over part of the heart’s workload. In time, the reduced effort by the
heart may improve its function (See Figure 1).
When is ECMO used? ECMO is an option for those patients who have acute, life-threatening failure of the heart and/or lungs that is 1) not responding to other types of support and 2) felt by the patient’s physicians to likely be reversible (i.e. treatable). In cases of severe lung problems, ECMO would be considered when the lungs are so injured and sick that mechanical ventilators (breathing machines) are either failing or have such high settings that they may cause the lungs further harm or damage. ECMO functions as the patient’s lungs until the lungs have hopefully healed enough for the ventilator to again provide adequate support for the patient. ECMO does not replace treatments such as antibiotics or medications that help to remove edema/fluid from the lungs. The sole purpose of ECMO is to “buy time” for the patient’s lungs to heal from whatever disease process got them sick in the first place. Likewise, ECMO can be used to help a failing heart provide enough blood flow to the body to support vital organ function. This may sometimes be necessary either before or after heart surgery, or in cases of disease that seriously weaken the heart muscle’s ability to pump blood. Sometimes a patient’s heart is so weak that a heart transplant must be considered. If that is the case, ECMO may be used to help pump blood to the patient’s vital organs until a transplanted heart is obtained. This is called a “bridge” to a transplant. ECMO provides ample blood flow and oxygen to major organs like brain, liver, and kidneys helping them to maintain function during the child’s illness. At Arkansas Children's Hospital, ECMO has been successfully used for conditions such as:
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. Will my child hurt? Your child’s comfort is important to you and a priority to us. Before ECMO is initiated your child will receive medication to prevent pain and to help them rest during the procedure. Once on ECMO, your child will receive medication to relax and prevent pain continuously and may receive additional doses of medication at times to help them relax. Family involvement is important because you know your child best. We will need your assistance to improve your child’s comfort and in doing so assist your child to heal. Here are some of the things you can do:
What risks are there with ECMO? There are risks or complications that can occur while your child is on ECMO. The greatest of these risks is bleeding because your child will be getting a drug called heparin. Heparin plays an important role in that it reduces the formation of clots within the ECMO circuit. However, it reduces the patient’s ability to clot and causes increased risks for bleeding at surgical sites, internal bleeding, and an increased risk of bleeding in the brain. Newborns and young infants will have frequent ultrasound tests of their brains to help rule out any bleeding in the brain. Labs are run frequently to carefully adjust the amount of heparin used and to monitor other blood products that assist in clotting. Small blood clots or emboli pose an additional risk and can be introduced into the patient’s blood stream from the circuit. The circuit has many moving parts that work together to provide support for your child and mechanical failure can occur. These failures are extremely rare; however, the risks for blood loss and the introduction of air to the patient can cause damage to organs, the brain, and even death. The circuit is monitored frequently by a highly trained specialist who will respond to any and all emergencies that may arise. There are additional risks such as those associated with the transfusion of blood products. There is a slightly increased risk of infection related to the direct contact of the ECMO circuit with the patient’s blood stream. There may be associated risks with patient transport for procedures such as cardiac lab, surgery, CT scan, or any other major movement required for patient care. When will my child come off ECMO? There are two reasons for a patient to come off ECMO:
Most patients improve enough for ECMO support to be weaned or slowly turned down to the point that a surgeon can take them off the device. These patients have improved enough to come off ECMO but usually still require many forms of traditional intensive care treatments such as breathing machines and medications.
Email Family of an ECMO
Patient 
Arkansas Children's Hospital, 800 Marshall
St., Little Rock, AR 72202-3591, (501) 364-1100 or TDD (501) 364-1184
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