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Extracorporeal membrane oxygenation (ECMO) is a way to provide breathing and heart support. It’s usually used for critically ill infants with heart or lung disorders. ECMO can provide necessary oxygenation to an infant while doctors treat the underlying condition. Older children and adults may also benefit from ECMO under certain circumstances.
ECMO uses a type of artificial lung called a membrane oxygenator to oxygenate the blood. It combines with a warmer and a filter to supply oxygen to the blood and return it to the body.
Doctors place you on ECMO because you have serious, but reversible, heart or lung problems. ECMO takes over the work of the heart and lungs. This gives you a chance to recuperate.
ECMO can give the tiny hearts and lungs of newborns more time to develop. ECMO may also be a “bridge” before and after treatments like heart surgery.
According to Cincinnati Children’s Hospital, ECMO is necessary only in extreme situations. In general, this is after other supportive measures have been unsuccessful. Without ECMO, the survival rate in such situations is around 20 percent or less. With ECMO, the survival rate can rise to 60 percent.
For infants, conditions that may require ECMO include:
A child might need ECMO if they experience:
In an adult, conditions that might require ECMO include:
ECMO consists of several parts, including:
During ECMO, the cannulae pump blood that is depleted of oxygen. The membrane oxygenator then puts oxygen into the blood. Then it sends the oxygenated blood through the warmer and filter and returns it to the body.
There are two types of ECMO:
A doctor will check an individual before ECMO. A cranial ultrasound will ensure there’s no bleeding in the brain. A cardiac ultrasound will determine whether the heart is working. Also, while on ECMO, you will have a daily chest X-ray.
After determining that ECMO is necessary, doctors will prepare the equipment. A dedicated ECMO team, including a board-certified physician with training and experience in ECMO will do the ECMO. The team also includes:
Depending on your age, surgeons will place and secure the cannulae in the neck, groin, or chest while you are under general anesthesia. You will usually remain sedated while you’re on ECMO.
ECMO takes over the function of the heart or lungs. Doctors will perform close monitoring during ECMO by taking X-rays daily and monitoring:
A breathing tube and ventilator keep the lungs working and help remove secretions.
Medications will transfer continuously through intravenous catheters. One important medication is heparin. This blood thinner prevents clotting as blood travels within the ECMO.
You can stay on ECMO anywhere from three days to a month. The longer you remain on ECMO, the higher the risk of complications.
The biggest risk from ECMO is bleeding. Heparin thins the blood to prevent clotting. It also increases risk of bleeding in the body and brain. ECMO patients must receive regular screening for bleeding problems.
There’s also a risk of infection from the insertion of the cannulae. People on ECMO will likely receive frequent blood transfusions. These also carry a small risk of infection.
Malfunction or failure of ECMO equipment is another risk. The ECMO team knows how to act in emergency situations like ECMO failure.
As a person improves, doctors will wean them off of ECMO by gradually reducing the amount of blood oxygenated through ECMO. Once an individual gets off ECMO, they’ll remain on the ventilator for a period of time.
Those who have been on ECMO will still need close follow-up for their underlying condition.
Written by: Danielle Moores
Medically reviewed on: Jan 04, 2017: University of Illinois-Chicago, College of Medicine
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