ECMO

WHAT IS ECMO?

ECMO stands for Extra Corporeal Membrane Oxygenation. It is a machine that helps provide support for patients with a sick heart, lungs or both. ECMO is used when traditional medical treatments have failed. ECMO does not treat the patient's disease; it only supports the body while it tries to get better.

The goal of the ECMO machine is to improve oxygen delivery to the body and remove carbon dioxide (CO2) while the heart and/or lungs recover. Patients often require the support of ECMO for many days and sometimes even weeks. Patients on ECMO also require an intensive care unit setting, as well as a special ECMO team.

Patients who require support only for their lungs are on VV ECMO, while patients who need support for their heart are on VA ECMO. A special machine is used to remove blood from the patient's vein, pass it through tubing (oxygenator) where oxygen is added to the blood and carbon dioxide (a gas you breathe out) is removed. This oxygen-rich blood is then returned to the patient's body.

TYPES OF ECMO:

VV ECMO: Veno-venous (VV) ECMO takes blood from a vein and returns it to a vein. It is used to support sick lungs.

VA ECMO: Veno-arterial (VA) ECMO takes blood from a vein and returns it to an artery. VA ECMO supports both the heart and the lungs when they are sick.

INDICATIONS OF ECMO:

The following are some of the indications for ECMO therapy:

1. Acute respiratory distress syndrome (ARDS): ECMO can provide respiratory support for patients with severe ARDS that is refractory to conventional mechanical ventilation.
2. Cardiogenic shock: ECMO can provide circulatory support for patients with severe cardiogenic shock that is refractory to conventional therapies, including medication and mechanical ventilation.
3. Pulmonary embolism: ECMO can provide respiratory support for patients with massive pulmonary embolism that is causing severe respiratory distress and hypoxemia.
4. Post-cardiotomy shock: ECMO can provide circulatory support for patients who have developed refractory cardiogenic shock following cardiac surgery.
5. Submersive Drowning, Celphos Poisoning (Aluminium phosphide), Drug Intoxication (Cardiac drugs), Refractory Bronchial Asthma, Fulminant Myocarditis, Malignant Arrhythmia Storm, Peripartum Cardiomyopathy
6. Bridge to transplant: ECMO can be used as a bridge to transplantation for patients with end-stage cardiac or respiratory failure who are awaiting a transplant.
7. Bridge to recovery: ECMO can provide temporary support for patients with reversible respiratory or cardiac failure, allowing time for the patient's underlying condition to improve.
8. Trauma: ECMO can provide support for patients with severe trauma, such as lung contusions or traumatic cardiac arrest

The specific indications for ECMO depend on the underlying condition and the patient's overall health. ECMO can provide temporary support, allowing time for the patient's underlying condition to improve or to facilitate further treatment.

HOW IS A PERSON PLACED ON ECMO?

The ECMO team, who are trained in cannulation will place the tubes. This will often take place at the bedside, but sometimes it will take place in the operating room.

In VA ECMO, one tube will be placed in a large vein and another in an artery. In VV ECMO, both tubes are placed in a vein. These tubes are then hooked to the ECMO machine.

THE ECMO MACHINE:

Blood flows through the tubes, by gravity, and is pushed along by the turning motion of the pump. As the blood goes to the machine it puts oxygen into the blood and takes out carbon dioxide. The blood is then warmed to body temperature and given back to the patient.

As the patient gets better, the ECMO team will set the machine to do less work. The amount of time this takes depends on how the heart and/or lungs heal.

REMOVING THE ECMO:

When the patient has gotten well enough, the ECMO machine can be stopped and the cannulas (thin tubes) will be removed. This is usually done in the patient's room. Sometimes it is done in the operating room. This is called decannulation. The patient will remain on the ventilator to help assist with their breathing. As the patient gets better over the next days to weeks, they will hopefully no longer need the ventilator.