What is an ECMO?
Extracorporeal membrane oxygenation (ECMO) is a form of artificial life support that can assist a patient whose lungs and heart are not functioning properly. Continuous extracorporeal membrane oxygenation (ECMO) removes blood from the body and transfers it through devices that add oxygen and remove carbon dioxide. The heart then circulates blood back into the body.
Treatment with ECMO can be exceptionally beneficial in allowing the heart and lungs to rest and recover from a respiratory infection, heart attack, or trauma.
Who can benefit from ECMO treatment?
ECMO treatment is recommended by doctors for individuals experiencing severe trauma, infection, cardiac arrest, lung failure, or heart failure. It is used to stabilize critically ill patients while doctors diagnose their condition or initiate treatment. ECMO can also provide vital support for oxygenating the blood and maintaining circulation for individuals awaiting heart or lung transplants.
How is ECMO preparation handled?
Given that ECMO is a life-saving procedure, it typically occurs in an emergency care setting, where the medical team, including the doctor, prepares the patient for the treatment.
The ECMO Procedure:
Placement on ECMO involves a surgical procedure, typically performed in the patient's room. Here's what to expect:
1. Sedation and Medication: The patient receives sedation, pain relief, and an anti-coagulant to prevent blood clotting.
2. Catheter Insertion: A surgeon, supported by an operating room team, inserts ECMO catheters into arteries or veins. X-rays confirm their correct placement.
3. Ventilator Support: Most ECMO patients also require a ventilator to aid lung healing during treatment.
4. Specialized Monitoring: Specially trained nurses, respiratory therapists, surgeons, and the surgical team closely monitor the patient throughout ECMO therapy.
5. Nutritional Support: While sedated with a breathing tube, nutrition is delivered intravenously or through a nasal-gastric tube.
6. Medications: Various medications may be administered, including heparin to prevent blood clots, antibiotics to prevent infections, sedatives for comfort, diuretics to manage fluids, electrolytes to balance salts and sugars, and blood products if needed.
Discontinuation of ECMO:
To end ECMO therapy, a surgical procedure is required to remove the tubes. Several tests are conducted to ensure the patient's heart and lungs are ready. Once the ECMO cannulas are removed, the vessels are repaired, either at the bedside or in the operating room. The doctor uses small stitches to close the insertion site, and the patient is monitored while asleep. Even after ECMO discontinuation, ventilator support may still be necessary.
Potential Risks of ECMO:
- Bleeding: There is a risk of bleeding, often associated with the medication administered to prevent clotting in the tubing.
- Infection: Infections may occur at the insertion sites of the tubes where they enter the body.
- Transfusion Complications: Individuals on ECMO may require blood products, which can introduce potential complications.
- Formation of Clots or Air Bubbles: Small clots or air bubbles can develop within the tubing, posing a risk.
- Elevated Stroke Risk: There is an increased likelihood of stroke associated with ECMO treatment.
