Overview
In extracorporeal membrane oxygenation, blood is pumped out of the body and through a ventilator. The blood flows across an artificial membrane and comes in contact with oxygen before it returns to the body. This process ensures that enough oxygen is available for life-sustaining functions, including brain function, heart function, and lungs. ECMO is often used to treat infants who have severe lung disease or a condition that makes it hard to breathe.
Features of ECMO include oxygenation, carbon dioxide removal, and blood pressure support. The membranes consist of hollow fibers attached in parallel on both sides of an oxygenator/heat exchanger that is filled with a physiologic solution (usually an electrolyte containing solution.) In order to function the device requires heat exchange, filtration and gas exchange in a closed circuit with return blood pumped by the heart. This allows blood flow through the lungs (cardiopulmonary bypass) while they perform their gas exchange function thus offloading the heart and lungs due to decreased workload on them during critical illness at birth.
ECMO is used to treat infants and small children who have severe lung disease or a condition that makes it hard to breathe (such as cystic fibrosis). The use of ECMO in these cases has been shown to improve survival. A significant number of patients have had significantly better survival with ECMO compared to standard care.
ECMO is also an effective treatment for some types of brain injury, such as those that occur following cardiac arrest where once the heart begins beating again, blood flow can be resumed. It is used to provide oxygenation and carbon dioxide removal for organs in the body that cannot receive adequate oxygenation from the blood such as the brain, liver, kidneys and lungs.
The ECMO procedure is done in a hospital or at home. The lungs are expanded so that they can receive the blood and oxygen, but only to a limited extent because the lungs can only expand so much. About 60% to 80% of the blood will flow through the lungs and out of them into the ECMO machine. The remaining blood is pumped through other portions of the body, including the brain and heart. Sometimes, it is necessary to do bypass surgery to remove the blood from around these organs and return it to them via ECMO.
ECMO requires the attachment of nine to twelve tubes to the body and must be done in an intensive care unit under constant supervision. The most common problem with ECMO is bleeding inside the chest. This can be minimized by making sure that all anti-clotting medications are removed from the body, or by using drugs to keep the blood from clotting.
The ECMO procedure takes four hours or longer, and is expensive (about $250,000). A person needs to remain on ECMO for one to six weeks, so it is important that he/she improve enough during this time so that he/she can be taken off ECMO.
ECMO is used to supply oxygen and remove carbon dioxide from the lungs of a person after cardiopulmonary bypass for a serious medical condition.
The most common reason for ECMO is pulmonary hypertension, but it may also be used for treatment of other conditions such as cardiac arrest and brain injury.
ECMO is used in stroke patients. It is not clear if ECMO improves the outcome after stroke or if it just delays death several days or weeks. In some cases studies have shown death to be delayed by a greater amount when ECMO was used, however there are other studies which show no difference in mortality between groups using ECMO and ones not using it.
ECMO is used in newborn babies with meconium aspiration syndrome.
ECMO is used in children and adults who have a lack of oxygen getting to the brain. It may also be used in children born with only one lung or when an adult has a lung problem.
ECMO is also used in adults with severe heart failure who cannot breathe without it. This is called cardiogenic pulmonary edema and heart failure.
The ECMO procedure is done to increase the amount of blood flow to a person's lungs (often due to heart or lung disease) or brain (often due to stroke).
ECMO is often used after a heart attack to keep the person alive while they are being treated.
The ECMO machine is used in cardiac surgery to keep people alive during complex or long procedures.
ECMO may be used to help with the following conditions:
A person who has ECMO will need a gastrointestinal tube and a breathing tube (a tracheostomy), along with other tubes for blood tests and fluid replacement. He or she will also be given medications, and will probably be connected to an IV. This means that someone must always be there when the patient is on ECMO, and cannot go far away from the patient for long periods of time (at least eight hours per day).
The ECMO machine is noisy, and will prevent people from being able to talk over it.
Dangers include lung infections, bleeding inside the chest or from a blood clot, and leaks in connection to the tubes placed in the body.
A person may get an infection after the ECMO procedure (especially if it is done for a long time). This can range from fever to getting very sick. There are also certain medications that can increase a patient's chance of getting an infection while on ECMO. These include antibiotics and other drugs given through the IV lines.
ECMO-related mortality rates have been reported to be around 30%.
ECMO is used on adults and children who are severely ill and cannot be kept alive by the regular operation of their heart and lungs.
ECMO is a life support technique used to provide oxygenation to the organs of a person who cannot do this on their own. The ECMO machine is like a heart-lung machine, but it takes up less space in the body. During ECMO, blood is taken from the body while oxygenated blood is pumped back into it from an external tank of carbon dioxide removal solution. The body can receive enough blood during ECMO to maintain vital organs such as the heart and brain but will not recover or return to normal function once ECMO is discontinued.
