Extracorporeal Membrane Oxygenation (ECMO)

Extracorporeal Membrane Oxygenation (ECMO), also known as mechanical circulatory support, is a life support machine. The ECMO machine replaces the function of the heart and lungs. “Extracorporeal” means the blood circulates outside the body and “membrane oxygenation” refers to the machine’s ability to deliver oxygen directly to the blood.

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ECMO is used to help people whose lungs cannot provide enough oxygen to the body; even when given extra oxygen, lungs cannot get rid of carbon dioxide even with help from a mechanical ventilator, and heart cannot pump enough blood to the body. ECMO may also be used to support people with heart or lung disease that cannot be cured while they wait for an organ transplant (for example, new heart and/or lungs).

The ECMO machine is similar to the heart-lung by-pass machine. However, the biggest difference between an ECMO and a heart-lung machine is the time and purpose of use. The heart-lung machine is used for a matter of hours to provide support during cardiac procedures; while the ECMO is used for long-term support to allow recovery of the lungs and/or heart.

Types of ECMO

The ECMO machine is connected to a patient through plastic tubes (cannula). The tubes are placed in large blood vessels (veins and arteries) in the legs, neck or chest. The procedure by which a health care provider places these tubes in a patient is called cannulation. There are two types of ECMO:

  • The V-A ECMO: During this procedure, your doctor will place two cannulas (one in a large vein and one in a large artery) so that blood can be taken out of a vein and returned into an artery. This type of ECMO supports both heart and lung function.
  • The V-V ECMO: During this procedure, your doctor will place the cannula in a large vein only (usually in the neck). Based on the patient’s age and condition, your doctor may choose to place one special cannula in a single vein or place two cannula in two different veins. The special cannula in one vein has two channels, side by side, allowing the ECMO pump to draw blood out through one channel and back in through the other. This type of ECMO supports lung function primarily.

How to Prepare for the Procedure

ECMO is done on emergent basis and never as a scheduled procedure, thus, giving an individual no time to prepare. A dedicated team of clinicians trained in ECMO will determine suitability, with each case being determined on an individual basis.

What to Expect Before the Procedure

Before an ECMO, your doctor may perform a variety of tests, including the following diagnostic tests and procedures:

What to Expect During the Procedure

On average, ECMO support lasts anywhere from 5 to 14 days, but some individuals may require to stay on it longer. The length of support depends mainly on the type of lung or heart problem. The procedure usually takes place bedside or in the operating room (OR). Check with your doctor about the details of your procedure. In general, during a V-A ECMO:

  • A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure.
  • Prior to starting the procedure, you will also receive a local anesthetic. Once the anesthetic has taken effect, your doctor may insert a breathing tube through your throat into your lungs and connect you to a ventilator.
  • Patients who are on an ECMO machine may be given medicines (sedatives or pain controllers) to keep them comfortable. These medicines may also make you feel sleepy. Other patients are awake and can talk and interact with people while on an ECMO machine.
  • Your doctor will then proceed with placing two cannulas in large vessels on: side of the neck, directly into the chest, or into groin vessels.
  • The cannulas are of blue and red colors.
  • The blue cannula takes de-oxygenated (without oxygen) blood, which has circulated through the body, out of the heart and into the ECMO machine. The ECMO machine adds oxygen to it. This oxygenated (with oxygen) blood is then pumped into the aorta (body’s main artery) through the red cannula.
  • This process will continue until you are taken off ECMO. The decision to discontinue ECMO is up to your doctor and based on multiple tests confirming your heart and lungs readiness to properly function.
  • Once the ECMO cannulas are removed, the vessels will need to be repaired.

What to Expect After the Procedure

After the procedure, you may be taken to the recovery room or intensive care unit (ICU) for further observation. The time spent in the hospital will vary according to your particular condition. What will happen next is:

  • A nurse will continue to monitor your vital signs.
  • You will have a tube in your throat that connects to a ventilator until you are stable enough to breathe on your own.
  • You may be on special IV medicines to help your blood pressure and to control any problems with bleeding.
  • At the appropriate time, you will be helped out of bed to walk around as determined by your doctor.
  • Nurses, respiratory therapists, and physical therapists will work with you as you begin physical therapy and breathing exercises.
  • Your doctor will give you instructions to follow during your recovery.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.

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