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Extracorporeal Membrane Oxygenation (ECMO)

Extracorporeal membrane oxygenation (ECMO) or extra corporeal membrane life support (ECLS) is a tool that replaces the function of the lungs and heart when they can no longer function normally, even with medication or a ventilator, until the heart and lungs can be treated so they resume normal function. The ECMO will pump blood instead of the heart and will exchange oxygen instead of the lungs. The ECMO removes blood from the body and moves it through a pump (that functions like the heart) and then it is filtered through a membrane oxygenator that adds oxygen and removes carbon dioxide (functioning like the lungs). The blood is then returned to the body. The mechanism is same as that of a cardiopulmonary bypass machine. A doctor will place the cannula into a large vein and a large artery at the leg or neck.

Indication for ECMO
  • Patients who need respiratory support only.
  • Patients who need both cardiac and respiratory support, especially in patients with severe problems.
  • ECMO may even be indicated while CPR (cardiopulmonary resuscitation) is being carried out.
The doctor will assess the patient to make sure that there is no bleeding in the brain and whether the condition or disease the patient is experiencing can be resolved and the patient can return to normal health.
 
The doctor will then insert the cannula into a large vein and artery around the patient’s leg or neck by using echocardiography to find the blood vessels. The procedure can be done at the patient’s bedside in the Intensive Care Unit (ICU), patient’s ward, or the Emergency Room (ER) in an emergency. In non-emergency situations, the procedure is done in an Operating Room (OR).
 
The patient’s vital signs will be monitored, including the heart rate, respiratory rate, blood pressure, levels of oxygen and carbon dioxide in the blood, and the circulation. They will also be monitored for any infections or complications.
 
  • Bleeding, due to the blood thinning medication that is given to prevent blood from clotting in the tubing.
  • Infection at the insertion sites.
  • Transfusion problems, since a person on ECMO is given blood products.
  • Small clots or air bubbles forming in the tubing, in the heart, or in the membrane oxygenator.
  • Increased chance of stroke if a blood clot forms in the left chamber of the heart.
  • Some patients on ECMO may experience kidney problems.
  • Some patients may experience decreased blood flow to the legs, leading to serious leg damage. This complication can be prevented by inserting a small catheter to deliver blood to that leg (distal perfusion).
The ECMO machine can support a patient until they are through the critical situation or have recovered from their serious injury. If the disease of injury improves, the doctor will slowly reduce the amount of ECMO support. Once the patient is fully improved or remains stable, the ECMO tubes may be removed and a ventilator may be used instead.
 
It is not recommended to move a patient on ECMO. If the patient must be moved, they can be moved with an ECMO transport.
 
The success of the ECMO depends on the speed of decision making using ECMO. Information from the Extracorporeal Life Support Organization (ELSO) finds that:
  • Survival rate for ECMO for the heart is 50%.
  • Survival rate for ECMO for the respiratory system is 50%.
  • Survival rate for extracorporeal cardiopulmonary resuscitation (ECPR) is 30%.
 
What may happen if the patient does not have the procedure?
The patient will experience brain death due to lack of oxygen and may die if their heart and lungs are not working.
 
 
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