Extracorporeal Membrane Oxygenation (ECMO)

What Is ECMO?

Extracorporeal membrane oxygenation (ECMO) is when a specially trained medical team uses a machine to do the work that the heart and lungs normally do.

Why Is ECMO Done?

When the heart or lungs stop working, ECMO (EK-moe) can do their job for days, weeks, or even longer.

Often, that's long enough for:

• the medical team to fix the problem, such as with heart surgery
• the heart or lungs to heal from a problem, such as asthma or meconium aspiration
• a child to get a heart transplant or lung transplant

Children can have heart or lung failure for lots of different reasons. ECMO can help kids who have:

• heart failure because of a disease, such as hypoplastic left heart syndrome (HLHS) or cardiomyopathy (heart muscle weakness)
• lung failure because of a disease (such as pneumonia, asthma, or meconium aspiration syndrome) or before a lung transplant for cystic fibrosis
• organs or body systems that didn't develop properly while the baby was in the womb, causing the heart or lungs to fail, such as congenital diaphragmatic hernia or congenital heart disease
• infections that cause the organs to shut down, such as sepsis

What Does an ECMO Machine Do?

The ECMO machine, using a pump that works like the heart, pumps blood from the body through an artificial lung. Like a normal lung, it adds oxygen to the blood and removes carbon dioxide. Then the machine sends the blood back to the child.

The machine is run by an ECMO specialist, who can be:

• a perfusionist
• a nurse or respiratory therapist with special training in ECMO

How Is ECMO Done?

There are two kinds of ECMO:

• Veno-venous (VV) ECMO: This is used when the heart is working but the lungs need time to rest and heal. It takes blood from a large vein, adds oxygen, removes carbon dioxide, and returns the blood to a vein.
• Veno-arterial (VA) ECMO: This is used when both the heart and the lungs need to rest and heal. It takes blood from a large vein and returns it to an artery. The heart continues to beat and pump blood, but doesn't have to work as hard as it did before ECMO started.

Usually during ECMO, medicines keep the child asleep and still. A breathing machine (ventilator) moves air in and out of the lungs to keep them healthy. Sometimes, ECMO can be used while the child breathes on his or her own without a breathing machine.

What Happens Before ECMO?

If a care team thinks ECMO might help your child, they will assess all health problems. The team includes specialists in:

• newborn or pediatric intensive care
• pediatric surgery
• lung problems (pulmonology)
• heart problems (cardiology)
• heart and chest surgery (cardiothoracic surgery)

The ECMO doctor or surgeon will talk to you about the risks and likely benefits of ECMO. If you choose ECMO, you will sign a parental consent (permission) form.

Starting ECMO takes several steps. The treatment team:

• puts medicine into the IV so your child will sleep, have no pain, and won't move
• inserts a breathing tube and attaches it to a ventilator (if your child isn't already using a ventilator)
• gives your child medicines to keep the blood from clotting
• places cannulas (long, thin tubes) through an artery and/or vein and guides the tips to the heart
• uses ultrasound scans or X-rays to be sure that the tubes are in the right place
• starts ECMO

What Is ECMO Transport?

A mobile ECMO team can safely move (transport) a child who needs ECMO from one hospital to another hospital. ECMO transport is used when:

• a child is in a hospital that doesn't offer ECMO
• a child must be moved to another hospital for an organ transplant or other care

When a child is in a hospital that doesn't have ECMO, the mobile ECMO team will:

• go to the hospital to assess the child
• start ECMO on the child, if needed
• continue ECMO while moving the child to the other hospital

Sometimes, members of the mobile ECMO team may visit the child or use a mobile device to assess the child remotely before sending the full team with ECMO equipment. The ECMO team will decide if ECMO transport and treatment at the other hospital are likely to help the child.

Can I Stay With My Child During ECMO?

You can stay with your child at least some of the time during ECMO. It helps your child to hear your voice and feel your touch.

How long you can stay depends on how well your child is doing and what kind of medical care is needed. The team will let you know when you can stay and when to step out so they can do tests or treatments to help your child.

How Long Does ECMO Take?

A child may be on ECMO from a day to over a month or more. It all depends on the child's health problem.

What Happens After ECMO?

The care team will do several tests to be sure ECMO is no longer needed, then turn off the machine and remove the tubing. Your child will be eased off the ventilator as he or she adjusts to breathing without ECMO. This may take days or weeks.

Your child might need heart medicines until the heart is fully recovered. The care team will continue to carefully watch your child and give pain medicines to keep him or her comfortable.

What Problems Can Happen From ECMO?

ECMO has significant risks. So doctors use it only when they've tried all other treatments and believe that ECMO will help.

Risks include:

• bleeding
• bubbles or clots in the blood that may block blood vessels
• infection
• problems with the machine

ECMO also can have some side effects, like swelling (edema), which is especially common during the first few days. The swelling usually goes away by the time ECMO is finished.

How Can Parents Help After ECMO?

Children need extra support as they recover after ECMO. Some kids may have lung problems if ECMO did the work of the lungs. Others might have some trouble walking or talking, or have a hard time with their schoolwork.

Ask the ECMO team and your child's pediatrician about ways you can help.

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