ECMO stands for Extracorporeal Membrane Oxygenation. You may also hear
the names ECLS or Extracorporeal Life Support. These terms mean the same
thing. ECMO is a specialized procedure that takes over the functions of
the heart and/ or lungs when those organs are too sick to properly support
the body. ECMO does not cure these organs, but instead gives them time
to heal. When the lungs are too sick or injured, they are unable to provide
oxygen and remove carbon dioxide (a waste product) as they normally would.
And when the heart does not function properly, ECMO can do most of its
work, allowing the heart to rest.
ECMO is similar to the heart-lung bypass used in the operating room, but
it is used for a longer period of time. The ECMO pump requires an ECMO
specialist to watch and maintain it 24/7. The specialist and a nurse will
be at your child’s bedside around the clock and will only step away
if another skilled clinician takes their place.
ECMO evolved in the late 1960s and early ’70s based on the idea of
the heart-lung machine used in cardiac surgery. This evolution filled
the need to provide extended life support. Children’s Hospital’s
ECMO Program was founded in 1999 and averages approximately 20-30 ECMO
cases a year. Currently, there are approximately 255 ECMO centers in the
country and numerous centers around the world.
We provide ECMO for patients from newborns to adults. The patients that
meet our criteria and progress to ECMO generally have a mortality rate
(chance of dying) of 80-90 percent without ECMO. The patient must have
a reversible process, or a curable condition, and have good brain function.
Some of the reasons patients go on ECMO are:
Pneumonia
Trauma
Severe Infections
Congenital Heart Defects (CHD)
Asthma
Congenital Diaphragmatic Hernia
Persistent Pulmonary Hypertension of the newborn (PPHN)
Respiratory Distress Syndrome (RDS)
Sepsis
Respiratory Failure
Low cardiac output; poor perfusion (passage of fluid through the circulatory
or lymphatic system)
Plastic tubes (cannulae) are placed into large vessels that lead directly
to the heart. The cannulae are placed either percutaneously (through the
skin, like an IV) or surgically (in a minor operation). If the patient
is placed on ECMO in the operating room, it’s very likely that the
cannulae will be placed directly into the heart. The patient’s size,
age, weight, and reason for ECMO will determine the size of the cannulae
and where they are placed. These cannulae allow blood to be drained from
the heart and through the ECMO circuit. The blood will be given oxygen
and carbon dioxide will be removed. The blood will be warmed and returned
to the patient through a separate cannula.
The goal of ECMO (depending on the type of ECMO) is to either let both
the heart and lungs, or just the lungs, rest. The purpose of ECMO is only
to allow time for healing, it does not necessarily fix the underlying
problem. Once the patient is placed on ECMO, the ventilator (breathing
machine) settings will be decreased to levels that will not damage the
lungs. Once the lungs and/or heart are healed, the ventilator settings
are increased and the patient is weaned from the assistance of ECMO.
Yes. There are two types of ECMO to support a patient:
VA (veno-arterial) ECMO. This type supports both the heart and the lungs,
and it requires the placement of two cannulae—one in a vein to drain
blood from the patient and one in an artery to return the blood to the patient.
VV (veno-venous) ECMO. This type is used for lung support only and requires
that only one cannula be placed in a vein.
Once the artery or vein has been used for ECMO, it will either be repaired
or tied off. Our surgeon will explain what is best for your child at this point.
If the doctor thinks your child needs ECMO, he or she calls in an ECMO
surgeon to review all the medical information. If the ECMO surgeon agrees
that ECMO is needed, one of the first steps of the process is to perform
a completely safe and painless cranial, or head, ultrasound, if applicable
(typically performed on newborns). This is to assure there is no bleeding
in the head. A cardiac echo is also performed to see if the patient’s
heart is normal. An operating team is called directly to your child’s
bedside to create a mini operating room, which is less disruptive to your child.
Here are the next steps:
Your child will receive medicine for pain and will be put to sleep with
the use of anesthetics
Your child will receive medicine that will cause their body to be temporarily
paralytic, which means the movement of their entire body will be restricted
The surgeon will make a small cut (incision) in your child’s neck
Two cannulae (for VA) or one cannula (for VV) will be placed:
For VA, one cannula is placed in the jugular vein and another cannula is
placed in the carotid artery
For VV, a double lumen cannula is placed in the jugular vein
The cannulae are connected to the ECMO circuit, which was filled with blood
while the cannulae were being placed
The ECMO machine is turned on
Your child is now on ECMO
If your child is placed on ECMO immediately following heart surgery, this
procedure will be done in the operating room. As stated above, the cannulae
would most probably be inserted directly into the heart. Your child would
then be brought into the Cardiac Intensive Care Unit (CICU) already on ECMO.
Two caregivers will be at your child’s bedside 24/7 while they are
on ECMO. One will be the ECMO specialist and the other will be a nurse
Once your child is on ECMO, the ventilator settings are reduced to “rest”
settings to avoid any lung injury
From this point until ECMO is removed, your child will not receive any
needle sticks
All bloodwork will be drawn from an existing arterial line and/or the ECMO pump
Blood gases and blood work (labs) will be drawn every six to eight hours,
chest X-rays will be taken every morning, and vital signs will be constantly monitored
It is common for ECMO patients to receive blood products more than once.
Do not be alarmed if your child must receive a blood transfusion. Our
blood bank will perform tests to make sure the products are safe and that
they are a match for your child’s blood type
Your child will continuously receive pain medication and sedation to ensure
their comfort
The drugs that prevent movement (paralytic) may or may not be removed.
This decision is based on numerous factors and is decided upon by the
attending physician or surgeon, but know that the use of paralytics helps
reduce the amount of oxygen that your child’s body needs to use
In some cases, ECMO patients need special procedures—such as CT scan,
heart catheterization, or a trip to the operating room—to help the
medical staff examine any changes that are occurring. The ECMO team will
take your child to the areas of the hospital where these procedures are
performed for optimal care, but chest X-rays will be done right at your
child’s bedside
Often, ECMO patients’ bodies need help with the production of urine,
even if a Foley catheter is already in place. We can help this process
by removing fluid from your child’s blood with special filters.
This can be done in line with the ECMO pump, or we may need to use a dialysis
machine, which will also be done through the ECMO pump
If your child develops a pneumothorax (“free” air outside of
the lung, which can cause a collapsed lung) or a pleural effusion (a buildup
of free fluid around the lungs—sometimes called “water on
the lungs”), a simple surgical intervention is needed. This procedure
is performed right at your child’s bedside for your child’s
comfort. A doctor makes an incision, and a tube is inserted there to help
remove the air or fluid causing the problem. Your child will not feel
any pain from this procedure
Your child’s endotracheal tube (breathing tube) will be suctioned
periodically to help remove secretions. The respiratory therapist may
also deliver breathing treatments through the ventilator to help your
child’s lung functions
You will be allowed to touch and comfort your child—that’s
really an important part of their treatment. Your child’s nurse
will show you the proper ways to touch so that you don’t affect
the ECMO system
Each ECMO case is different. The length of time your child will be on ECMO
will vary depending on numerous factors. Rest assured that we will update
you daily about your child’s progression
The greatest risk once your child is on ECMO is bleeding. Heparin, a blood
thinner, must be used so that the blood does not clot in the ECMO tubing
or in your child. Bleeding can occur anywhere in the body, but it is most
dangerous when it occurs in the brain. There is also a chance that some
blood clots may be introduced into your child’s bloodstream. The
ECMO circuit is closely monitored at all times by our highly trained specialists.
Every ECMO case is different in numerous ways. There are many different
medications that are used to assure the best outcomes. Below is a list
of some medications that might be used and their actions:
While on ECMO your child will receive all of their calories by one of two methods:
Total Parenteral Nutrition (TPN): This fluid contains vitamins, electrolytes,
and sugar that the body needs. Your child may also receive lipids, which
are fats to increase the calories given, via the TPN. These fluids are
given through an IV directly to your child, not via the ECMO pump
Tube: A special tube may be inserted through your child’s nose or
mouth until it reaches the stomach. Depending on your child’s size
and age, this food may be infant formula or a formula similar to Ensure
We closely watch for improvements each day and monitor all aspects of your
child’s heart and lung function. We can see how much air is in their
lungs and how easily their lungs fill and empty with each breath. We also
monitor your child’s blood gases, lab values, X-rays, the intake
of fluids and output of urine, heart function, and other aspects that
will be further explained to you by a member of your child’s care
team. When we think your child is ready, we will begin to wean them off
ECMO and increase the ventilator settings. Once your child meets the criteria
to be removed from ECMO, we will clamp off the ECMO circuit, and your
child’s heart and lungs will be performing their regular functions
once again. While the ECMO is clamped off, we will run blood gases and
monitor your child’s vitals. If your child is ready, the surgeon
will decannulate, removing the cannulae from your child’s system.
Your child will remain with a nurse at their bedside for approximately
24 hours. Your child will remain on the ventilator until they’re
able to breathe on their own. This is monitored by certain numbers on
the ventilator, blood gases, and vital signs. Time spent on the ventilator
will vary from child to child and will depend on how long your child has
been sick.
All of our ECMO patients are managed in either our Pediatric Intensive
Care Unit (PICU), Neonatal Intensive Care Unit (NICU), or Cardiac Intensive
Care Unit (CICU). Each ICU is open for visitors 24/7. The nurse caring
for your child will give you information on the unit’s policies.
If you are unable to visit, we are happy to give you phone updates.
Yes. Routine checkups with your Children’s Hospital specialists are
important. The number of follow-up visits will also be determined by how
well your child progressed with ECMO. A nurse will talk to you about follow-up
care and assist with scheduling appointments once your child is discharged.
ACT– Activated Clotting Time: This test shows how long it takes the
blood to clot. We monitor this at least once every hour.
Cannulae – Plastic tubes that are placed in either an artery or vein.
Cannulation – The process of placing the cannulae into the blood vessels.
Cardiac Catheterization – A small catheter is placed into a vein or artery and threaded
up to the heart. This allows us to look at the heart and monitor pressures
within the heart.
Cardiac Echo – Allows us to look at the heart using ultrasound.
Congenital Heart Defect (CHD) – There are many different heart defects. If your child is on ECMO
because of a heart problem, you will be given more information on the
specific defect by the cardiologist or surgeon.
Decannulation – The process of removing the cannulae from the blood vessels.
ECLS – Extracorporeal Life Support (same as ECMO).
ECMO – Extracorporeal Membrane Oxygenation.
ECMO flow – A measure of how much blood we are pumping through the ECMO circuit
to help support the patient.
ECMO team – Our ECMO team is made up of specially trained respiratory therapists,
nurses, perfusionists and physicians.
Oxygenator – A type of artificial lung. Carbon dioxide is removed and oxygen is added.
Percutaneous – Literally means “through the skin.” In this case,
the ECMO cannulae are put in like an IV. The other option is to surgically
place the cannulae.
Sodium bicarbonate/sodium acetate – Decreases acid levels in the blood.
Trial off/Clamp off – Temporarily stop the ECMO to measure the function of the heart
and/or lungs. If the function is good, the ECMO may be discontinued.
VAECMO – Veno-Arterial. We drain the blood through the ECMO cannulae from
a vein and return it to an artery. This type of ECMO is mainly used for
patients that need both heart and lung support.
VV ECMO – Veno-Venous. Blood is drained from a vein and returned through
a vein. This is required for patients who require only lung support.
