Extracorporeal Membrane Oxygenation (ECMO)

The Bristol-Myers Squibb Children’s Hospital (BMSCH) at Robert Wood Johnson University Hospital (RWJUH) offers ECMO (extracorporeal membrane oxygenation), a specialized cardiac and respiratory support system. We provide ECMO support to newborns, older infants, children and teens in need of cardiopulmonary support.

ECMO can give the lungs and heart time to rest and heal.

“Extracorporeal” means support that takes place outside the body.

“Membrane” refers to the type of artificial lung that’s used.

“Oxygenation” means supplying oxygen to the blood.

ECMO: Advanced Cardiopulmonary Support

ECMO, Critical Care Transport & Non-Critical Inpatient Transfers

If you are a physician or healthcare facility that needs to arrange a transport for a patient requiring ECMO, please call 1-866-66-BMSCH (1-866-662-6724).

The Bristol-Myers Squibb Children's Hospital at Robert Wood Johnson University Hospital
One Robert Wood Johnson Place | New Brunswick | NJ 08903

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ECMO Services We Offer

The ECMO machine is sometimes referred to as “the circuit” because the circulation of blood from the patient to the machine and back forms a loop. The machine’s pump moves blood from your child to the machine and back to your child through sterile plastic tubes. The ECMO oxygenator adds oxygen to the blood and removes carbon dioxide, just as functioning lungs would. Carbon dioxide is a waste gas that is usually removed from the blood by breathing.

A child’s condition may call for one of two different ECMO treatments:

Veno-Venous (VV): ECMO is used when the heart is working but the lungs need time to rest and heal. VV ECMO supports the lungs by providing gas exchange, but does not directly support the circulatory system or heart with pumping force.

Veno-Arterial (VA): ECMO is used when both the heart and the lungs need time to rest and heal. VA ECMO supports the lungs by providing gas exchange, and directly supports cardiac function.

ECMO Team Members

At Bristol-Myers Squibb Children’s Hospital, a team of physicians, nurses, respiratory therapists and other specialists will care for your child. As the first step in starting ECMO, a care team member will review the risks and benefits of starting ECMO with you. If you consent to initiate ECMO, a surgeon will proceed with the ECMO setup by inserting the tubes (a surgeon will also remove the tubes when treatment is finished).

Members of the ECMO team will visit you in your child’s room each morning to discuss a plan of care for that day.

Team members may include:

Attending Physician/Surgeon — the doctor in charge of your child’s care — the doctor in charge of the ECMO operation

ECMO Coordinator — the manager of the ECMO department who acts as an extra resource for the care team and is responsible for organizing the equipment and training the people required to perform ECMO

ECMO Physician — a doctor who specializes in ECMO treatment in providing anesthesia and/or sedation, supporting vital functions and pain management

Respiratory Therapist — a specialist in ventilators (breathing machines) and lung care

ECMO Specialist — a nurse who is specially trained to monitor and manage the ECMO circuit

Nurse — a pediatric nurse who cares for your child in the hospital

Nurse Practitioner or Advanced Practice Nurse — a nurse with advanced training and education who provides care under the guidance of the Attending Physician/Surgeon

Social Worker — a professional who helps families deal with the experience of having a child in the hospital

What to Expect If Your Child Receives ECMO

To provide a direct line to your child’s heart, one or more plastic tubes called “cannulas” are surgically placed into large blood vessels of your child’s body, most often in the neck, leg or chest. The tubes drain blood from the heart into the ECMO circuit. As the blood is pumped through the circuit, oxygen is added and then the blood flows back into your child’s body. With the machine helping, the lungs and/or heart have a chance to recover.

Even though the ECMO machine is doing most of the work for the lungs, your child will also use a breathing machine called a “ventilator.” The ventilator works through a tube in the nose or mouth that sends just the right amount of air pressure in and out of the lungs. The moving air helps your child’s lungs stay slightly expanded.

Many children become very swollen during their first few days on ECMO. The swelling, known as “edema,” may be unsettling to see, but the care team is familiar with this side effect and will make sure the ECMO machine is working properly. Usually, much of the edema disappears by the end of ECMO treatment.

In most cases, children are sedated (asleep) while on ECMO. Those who are awake are protected from pain or discomfort with pain medication given through an IV (a small tube inserted in a vein) or directly into the ECMO machine. We can give extra doses of pain medication if your child seems uncomfortable.

Conditions that may require ECMO

ECMO is a treatment for serious problems of the heart or lungs (or both). It’s used when a patient’s heart or lungs are too sick to continue supporting the patient’s life and all other treatments that could help them work better have been tried.

The most common conditions that may lead to the need for ECMO treatment include:

Acute Respiratory Distress Syndrome: (ARDS, a life-threatening lung condition that prevents adequate oxygenation of blood circulating through the lungs)

Cardiac Arrest: (a sudden stop in effective blood circulation due to the failure of the heart to contract)

Cardiomyopathy: (heart muscle malfunction for genetic or other reasons)

Congenital Diaphragmatic Hernia: (when part of the stomach bulges through the diaphragm, which is an important breathing muscle

Low Cardiac Output Syndrome: (a decrease in heart output that causes an inadequate supply of oxygen for the body)

Meconium Aspiration Syndrome: (MAS; can develop when, either before or during birth, a baby inhales meconium, the dark green waste produced in the baby’s gut while still in the uterus)

Myocarditis: (infection of the heart muscle)

Neonatal Sepsis: (a bacterial bloodstream infection in a newborn)

Persistent Pulmonary Hypertension: (high blood pressure in the arteries that feed the lungs)

Pneumonias: (infection of the lungs)

Severe asthma