ECMO (Extracorporeal Membrane Oxygenation)

What is ECMO(Extracorporeal Membrane Oxygenation)?

In intensive care medicine, extracorporeal membrane oxygenation (ECMO)is an extracorporeal(outside of the body) technique of providing both cardiac and respiratory support oxygen to Patients whose heart and lungs are so severely diseased or damaged that they can no longer serve their function. Initial cannulation(insertion of a cannula) of a Patient receiving ECMO is performed by a surgeon and maintenance of the Patient is the responsibility of the ECMO Specialist and gives 24/7 monitoring care for the duration of the ECMO treatment. Because the heart and/or the lungs are so sick and unwell that these major organs stopped working properly and they are therefore unable to provide oxygen and blood to all the other important organs in the body, ECMO may be the treatment of choice for lung and/or for heart failure and ECMO may be a bridging therapy and/or a stepping stone towards organ transplantation for the lungs(Lung Transplantation) and/or the heart(Heart Transplant).

 

When is ECMO used?

Guidelines that describe the indications and practice of ECMO are published by the Extracorporeal Life Support Organization (ELSO). Criteria for the initiation of ECMO include acute severe Heart Failure or pulmonary failure(also Adult Respiratory Distress Syndrome (ARDS)) that is potentially reversible and unresponsive to conventional management. Examples of clinical situations that may prompt the initiation of ECMO include the following:

When is ECMO not used?

Most reasons to not use ECMO are relative, balancing the risks of the procedure (including the risk of using valuable resources which could be used for others) vs. the potential benefits. The relative reasons for not using ECMO are:

  1. Conditions incompatible with normal life if the Patient recovers
  2. Preexisting conditions which affect the quality of life (CNS status, end stage tumours, risk of systemic bleeding with anticoagulation)
  3. Age(+/- >65) and size of Patient
  4. Futility: patients who are too sick, have been on conventional therapy too long, or have a fatal diagnosis

How Does ECMO Work?

Extracorporeal means ‘outside the body’.  The ECMO machine in principal works like a Bypass machine(oxygenator) and is capable of exchanging oxygen and carbon dioxide in the blood of a human Patient, while critical organs such as the heart or the lungs have stopped working properly. Two large tubes have been surgically inserted into your loved one and if your loved one is in lung failure, the large tubes have been inserted into two veins(ECMO for lung failure is also called V-V ECMO) and if your loved one is in Heart Failure one of the two large tubes is inserted in an artery and the other one in a vein(ECMO for heart failure is called V-A ECMO). The blood coming from your loved one is pumped through the ECMO machine and the blood coming from your loved one is dark in colour (due to high carbon dioxide levels and low oxygen levels). The oxygenator adds oxygen to the blood and helps in lowering the carbon dioxide levels. The blood returning to your loved one is brighter in colour because of the improved oxygen level.

In Patients with Heart Failure V-A ECMO is instigated and dependent on your loved ones condition and pre-medical history he or she might be awake and spontaneously breathing without a ventilator.

In Patients with lung failure V-V ECMO is instigated and your loved one is mechanically ventilated with Ventilators (Breathing Machines) and a Breathing Tube or Endotracheal Tube. It is not uncommon for a Patient with lung failure to have a Tracheostomy inserted for long-term ventilation.

During ECMO the blood will be anticoagulated(thinned) by drugs such as Heparin(called anticoagulants) to prevent the blood from clotting. With the ECMO tubes pumping blood in and out of the body, careful and regular monitoring for infection and bleeding will take place.
ECMO machine used in a critically ill Patient in ICU

How Long Will It Be Used For?

ECMO can be used for a period of several hours to several days. In extreme cases ECMO may be used for several weeks. As the lungs or the heart recover, the ECMO machine will be weaned and removed. In order for the ECMO machine to be removed regular testing of vital parameters such as Cardiac output/ Cardiac Index and Arterial blood gases(ABG’s) are necessary.

In some instances, especially if V-V ECMO is required for lung failure, it may lead to Tracheostomy insertion and a long-term stay in Intensive Care with ventilator dependency. Your critically ill loved one therefore may go through a prolonged suffering in Intensive Care, leading to depression, stress and lack of Quality of Life and/or Quality of end-of-Life. You and your Family will very likely be stressed by the experience as well. If your loved one is long-term ventilated and wants to go home and have Quality of Life and/or Quality of end of life, check out www.intensivecareathome.com.au for more information

Are There Any Complications?

ECMO generally is a relatively risky intervention, with a potential beneficial payoff for the recovering Patient. In adults, ECMO survival rates are around 60%. Nevertheless are there several complications that may occur throughout the ECMO therapy

  • subarachnoid hemorrhage
  • hypoxic-ischemic encephalopathy
  • unexplained coma
  • brain death
  • Fatal sepsis may occur when the large tubes(catheters) inserted in the neck provide fertile field for infection
  • Additional risks include bleeding
  • thromboembolism(the formation of a blood clott)
  • vessel perforation through the tube(s)
  • Heparin-induced thrombocytopenia (HIT)

 

Any Questions?

Of course, if you have any questions or concerns, please discuss them with the ICU nurses and doctors.

All Intensive Care interventions and procedures carry a degree of potential risk even when performed by skilled and experienced staff. Please discuss these issues with the medical and nursing staff who are caring for your loved one.

The information contained on this page is general in nature and therefore cannot reflect individual Patient variation. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. INTENSIVE CARE HOTLINE attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual Patient. Please refer to the full disclaimer.

How can you have PEACE OF MIND, control, power and influence whilst your loved one is critically ill in Intensive Care?

You get to that all important feeling of PEACE OF MIND, CONTROL, POWER AND INFLUENCE when you download your FREE “INSTANT IMPACT” report NOW by entering your email below! In Your FREE “INSTANT IMPACT” report you’ll learn quickly how to get PEACE OF MIND, real power and real control and how you can influence decision making fast, whilst your loved one is critically ill in Intensive Care! Your FREE “INSTANT IMPACT” Report gives you in-depth insight that you must know whilst your loved one is critically ill or is even dying in Intensive Care! Sign up and download your FREE “INSTANT IMPACT” REPORT now by entering your email below!

In your FREE “INSTANT IMPACT” REPORT you’ll learn how to speak the “secret” Intensive Care language so that the doctors and the nurses know straight away that you are an insider and that you know and understand what’s really happening in Intensive Care!

In your FREE reports you’ll also discover

  • How to ask the doctors and the nurses the right questions
  • Discover the many competing interests in Intensive Care and how your critically ill loved one’s treatment may depend on those competing interests
  • How to eliminate fear, frustration, stress, struggle and vulnerability even if your loved one is dying
  • 5 “killer” tips& strategies helping you to get on the right path to PEACE OF MIND, control, power and influence in your situation
  • You’ll get real world examples that you can easily adapt to your and your critically ill loved one’s situation
  • How to stop being intimidated by the Intensive Care team and how you will be seen as equals
  • You’ll get crucial ‘BEHIND THE SCENES’ insight so that you know and understand what is really happening in Intensive Care
  • How you need to manage doctors and nurses in Intensive Care(it’s not what you think)

Make sure you also check out our “blog” section for tips& strategies and also check out our your questions answered section where we answer your questions or send me an email to support@intensivecarehotline.com with your questions!

Sincerely, your Friend
Patrik Hutzel

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