ECMO
MercyOne offers adult and pediatric ECMO services. Our dedicated team of specialists includes cardiothoracic surgeons, cardiologists, perfusionists, ECMO specialty nurses, critical care intensivists and nurses and respiratory therapists.
What is ECMO / ECLS?
ECMO stands for Extracorporeal Membrane Oxygenation and ECLS stands for Extracorporeal Life Support. Both terms are often used interchangeably. ECMO is a form of life support in which an external artificial circulation system carries blood from a patient, (via a centrifugal pump) to a gas exchange device (oxygenator). The blood is enriched with oxygen while carbon dioxide is simultaneously removed before the blood is returned back to the patient’s circulation. ECMO is used as temporary support of heart and/or lung function for a reversible disease process. It is very similar to a heart lung-bypass machine that is used during open-heart surgeries.
ECMO is NOT a treatment but it creates an environment that allows the heart and lungs the time they need to potentially recover. When lungs are sick or injured, they are unable to provide oxygen and remove carbon dioxide (waste) as they normally would. If the heart is sick or failing, it may not be able to adequately move blood (perfuse) the body enough to be compatible with life. Once a patient is placed on ECMO, the pump and oxygenator will take over the work of the patient’s heart and/or lungs so they have the opportunity to rest and recover.
Types of ECMO
There are two types of ECMO including VV (venous-venous) and VA (venous-arterial). The first letter of the acronym “V” indicates that blood is being drained from the patient’s venous system. The second letter indicates what type of vessel the blood is being returned to from the ECMO machine. Blood is either returned back to the venous system or into the arterial system. The ECMO care team will decide which type of ECMO is most appropriate.
VV ECMO offers lung support only. Blood is drained from the patient’s venous system, pumped to the artificial lung (oxygenator), and returned back into the patient’s venous system. VV ECMO takes over the work of the lungs but still requires a healthy heart to be able to pump the oxygenated blood to the rest of the body.
VA ECMO offers both heart and lung support. Blood is drained from the patient’s venous system, pumped to the oxygenator, and returned back into the patient’s arterial system. Since oxygenated blood is being directly infused into the arterial system, the pump is able to provide most of the patient’s cardiac output, thus allowing the heart and lungs to rest. This type of ECMO is used for patients with a sick heart that cannot adequately perfuse the body on its own.
Who needs ECMO?
ECMO is used for patients deemed to have reversible (not permanent) heart and/or lung disease. ECMO is used for patient’s not responding to maximal medical support such as high ventilator settings or a large amount of IV medications. Long-term use of maximal medical treatment can often cause further organ damage and decreases the chance of recovery. Placing the patient on ECMO gives the patient time to allow the heart and/or lungs to rest and other medical treatments to be eliminated or safely reduced.
Common Indications Include:
Acute respiratory failure, pulmonary embolism, pneumonia, influenza, aspiration, severe asthma, COPD, pulmonary hypertension, airway obstruction, septic shock, acute heart failure, cardiac stun, recurrent dysrhythmias, low cardiac output, cardiogenic chock, cardiac arrest, and failure to wean from bypass after cardiac surgery.
Your doctor and the entire ECMO care team at Mercy will decide if your child is a candidate for ECMO. The ECMO team will then present you with the option to proceed with initiation and all of the risks and benefits will be explained to you. The decision to place a patient on ECMO is often an urgent/emergent situation and may require timely decision-making. Any unanswered questions and concerns you may have will be promptly addressed once the patient is safely on ECMO and stabilized.
