Extracorporeal Membrane Oxygenation (ECMO)
Overview
Extracorporeal Membrane Oxygenation (ECMO) is a technique in which the blood is oxygenated when the lungs or heart stop working properly. The blood is pumped into the machine for oxygenation and the removal of carbon dioxide and is then sent to the body. It is a life-support system that is used in various life-threatening conditions such as stroke, lung infection, acute respiratory distress syndrome such as COVID-19, etc. It is commonly used in intensive care units (ICUs).
Alternate Name
Heart-lung machine
Body Location
For oxygenation of blood supplied to the body
Procedure Type
Surgical
How ECMO is Performed
ECMO is performed in the operation room. You will be sedated and given painkillers. You will also be given anticoagulation medication for minimising blood clotting. A breathing tube will be inserted through your mouth and nutrition will be provided through a nasogastric (NG) tube or intravenously. Your vitals such as blood pressure, heart rate, oxygen saturation, and respiration rate will be closely monitored during the procedure. The surgeon will place the cannulas: one in the vein to draw the blood into the machine, and the second in a vein or artery to send back the oxygenated blood. Following the procedure, the cannulas are removed and incisions are closed with sutures.
Preparation for ECMO
- ECMO is a life-support system that may be required after surgery or in critical conditions. So there is nothing much you can do to prepare for ECMO. However, your doctor will need to prepare for it, depending on the illness. He might order certain imaging tests such as cranial ultrasound to ensure proper blood supply to the brain and rule out bleeding in the brain.
- In addition, the doctor may order a cardiac ultrasound to examine the functioning of the heart and a chest X-ray to rule out any cardio-pulmonary complications. Respiratory therapists will train you on how to breathe during the procedure.
Follow-up
If you are being treated for a critical illness, you need to openly discuss with your doctor the options and choices after ECMO and the need for additional interventions. It is crucial to follow up with your doctor after ECMO to assess the recovery from the illness and also to inspect the need for additional ECMO. You need to follow the recommendations from your doctor related to the use of medications, lifestyle changes, etc. In addition, you need to take care of sutures at the site where cannulas or tubes were placed. Your family members also need to understand the process.
Risks of ECMO
ECMO is associated with various side effects and risks such as:
- Blood clot formation: It can lead to the formation of clots and thromboembolism. It can also lead to deep vein thrombosis or pulmonary embolism.
- Blood loss: Bleeding can occur from the sites of the cannula insertion, which can lead to coagulopathy disorders.
- Infections: Infections can occur at the site of the cannula and might require antibiotic treatment.
- Kidney failure: Impairment of kidney function is associated with ECMO as the kidneys might not get the required blood flow.
- In addition, seizures or strokes can occur in rare cases.
Recovery
The outcome of the procedure will depend upon the severity of the disease and your overall health condition. ECMO support can be provided for a few days to a few weeks. Recovery post discontinuation will involve taking care of the cannula site and following your doctor’s recommendations for any lifestyle changes. You need to take your medications as prescribed to ensure a quick recovery. In addition, visiting your doctor for all the follow-ups is crucial to assess the functioning of your heart and lungs. Based on your recovery and outcomes, your doctor will decide on the need to repeat the procedure.