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Extracorporeal membrane oxygenation (ECMO) supports the heart and lungs of seriously ill people by circulating blood outside the body through an oxygenation membrane. There are two types of ECMO, veno-arterial and veno-venous, and it is commonly used in pediatrics. However, it is a therapy of last resort due to the risks of heavy bleeding and blood clot formation. ECMO treatment is difficult for parents, but they are encouraged to touch, pet, and talk to their babies or toddlers.
Extracorporeal membrane oxygenation or ECMO is one way to support the heart and lungs of seriously ill people. Its most common application is in the pediatric field, but it can also be used for adults. ECMO was adapted from heart-lung bypass machines by Dr. Robert Bartlett of the University of Michigan Hospital in the 1970s and, unlike the bypass, can be used for longer periods of time, although a longer is associated with a greater degree of complications.
The “extracorporeal” in extracorporeal membrane oxygenation means that blood is circulated outside the body in the ECMO machine. The machine feeds blood through what’s called an oxygenation membrane, which can also be referred to as an artificial lung, which adds oxygen to the blood. The ECMO machine also needs to keep the blood at the proper temperature, so it doesn’t chill the body when it flows back. In all cases, the “blue blood” or oxygen-depleted blood becomes oxygenated and returns as “red blood” or oxygen-rich blood.
There are two types of extracorporeal membrane oxygenation, called veno-arterial and veno-venous (VA and VV). VA ECMO removes blood from a vein and returns it to an artery, bypassing the heart. This provides support for the heart and lungs. VV ECMO removes blood from a vein and returns it to a vein, and this tends to be used more when only the lungs are compromised. In both types, people can expect to see two catheters or cannulas attached to the body, one that removes blood and one that returns it.
The use of extracorporeal membrane oxygenation can be encouraged in many circumstances. Some of the reasons it may be applied include severely compromised lungs, waiting for a heart/lung transplant, heart transplant or cardiac surgery, immaturity of the lungs, meconium aspiration syndrome, and pneumothorax. The amount of days a person might spend on ECMO varies and may also depend on people who tolerate the therapy.
The risks of ECMO include heavy bleeding or blood clot formation. Heparin, a blood thinner, must be used to make sure the blood doesn’t clot in the machine. This use, especially in very young children, results in an elevated risk of bleeding into the brain. That’s why, while ECMO is considered an effective therapy, it is also considered a therapy of last resort.
Highly trained perfusionists closely supervise people on ECMO machines. Not all hospitals have these machines because they can only be used when there is a perfusionist to operate them and make sure the patient tolerates the treatment. ECMO treatment is more common in tertiary-level settings.
While extracorporeal membrane oxygenation can be seen as a good thing that can increase the survival rate with some conditions, it is not always enthusiastically received, especially by parents whose newborns undergo it. ECMO treatment is difficult for parents, who may not be able to hold or feed their babies for many days. They may, however, touch, pet and talk to their babies or toddlers, and this is highly encouraged.
