What is Ecmo?
What are the basics of ECMO?
Referencing the FAQ page on our website, extracorporeal membrane oxygenation, also known as ECMO, is a temporary heart-lung bypass technique used to oxygenate the blood and allow the lungs to rest.
Under sterile conditions at the bedside and once your baby has received pain medication, the pediatric surgeon will place two tubes called cannulas into the artery and vein in your baby’s neck. The tube in the neck takes blood out of the body from the large vein, oxygenates the blood through the ECMO circuit and returns the now oxygenated blood to the baby by the carotid artery.
ECMO is used when other treatments are unsuccessful. The lungs rest as the ECMO circuit does the work. In some cases, the baby may have the CDH repair while on ECMO. ECMO can have serious complications including bleeding and infection. Careful monitoring by an experienced ECMO specialist is critical.
Let’s break ECMO down
What does the acronym really stand for?
Extracorporeal: Outside the body
Membrane: A type of artificial lung
Oxygenation: The process of getting oxygen into the blood
Basically, ECMO is an advanced life support technique used for patients with life-threatening heart and/or lung problems. It provides long-term breathing and heart support and is used only when all of the standard treatments for those problems have already been attempted. As a highly specialized treatment, ECMO can support patients for days to weeks while doctors treat their underlying illness.
Give me more details on how it works
ECMO is performed using a heart-lung bypass machine similar to the one used during open heart surgery. The ECMO machine, often referred to as a “circuit,” is quite large and contains sterile plastic tubing that moves blood from your baby to the “ECMO lung” and then back to your child. The ECMO lung adds oxygen to the blood and removes carbon dioxide, as a healthy lung would.
There are two types of ECMO. Venovenous (V-V) ECMO is used when the heart is functioning well and only the lungs need to rest and heal. Venoarterial (V-A) ECMO is used when the heart as well as the lungs need to rest and heal.
When does a child need ECMO treatment?
There are a variety of medical issues and conditions that can require ECMO. Everything from meconium aspiration syndrome (MAS) to sepsis and even pneumonia. However, as you probably know, we tend to specifically focus on congenital diaphragmatic hernias (CDH). It’s a condition in which part of the stomach and/or intestines protrude through an opening in the diaphragm into the chest cavity.
What to expect when your child is on ECMO
Your child will run the gauntlet of medical procedures while on ECMO. It’s good to have a rough idea of what they’ll go through and what you can expect. Everything from surgically placed tubes (cannulas) and oxygen machines to specific medications and the variety of tests that will be completed. It’s important to know and understand some of what will take place.
Understand that the equipment being used to treat your child is quite delicate, so it is very important that you do not touch the machinery or the settings. For this reason, you won’t be able to hold your child while they are on ECMO.
The ECMO machine will be at your child’s bedside. Children, including infants, can hear and recognize the sound of their parents’ voices while sedated. Your child (and you) may find it comforting if you talk to them or hold their hand gently during this process.
Your child will come off of ECMO when the heart and lungs have recovered enough to function without the ECMO circuit. This can take several days or several weeks, and it depends on your child’s specific diagnosis and course of treatment. As daily test results begin to show progress, the medical professionals may slowly lower settings on the circuit to allow your child’s body to gradually function on its own, at which time the cannulas will be surgically removed.
For more in-depth information on what to expect when your child is on ECMO, visit this great article produced by the Children’s Hospital of Philadelphia.
Once the tubes are surgically removed, your child will need to remain on a ventilator to maintain oxygenation. Nitric oxide is a gas given through the ventilator to relax blood vessels. Over time, the goal is to wean your child slowly from the ventilator and medications. A nurse should continue to closely monitor vital signs and signs of pain and perform ordered lab work. While each child is different, be prepared that your child’s recovery period from ECMO may be measured in weeks and months, rather than days.
Questions regarding ECMO
Contact your nearest hospital to learn if they offer ECMO treatment. You can also visit the directory of extracorporeal life support organizations.