Extracorporeal Membrane Oxygenation (ECMO)

What Is ECMO?

Extracorporeal Membrane Oxygenation (ECMO) is a therapy used to support patients with severe heart and/or lung failure, using equipment that is similar to the machines used for cardiac bypass surgery in the operating room (OR).

There are two types of ECMO:

• Venoarterial (VA) ECMO – Uses a vein and an artery
• Venovenous (VV) ECMO – Uses one or two veins

The ECMO machine is made up of several parts including:

• A pump to move blood through the tubing
• An artificial lung (oxygenator) to remove carbon dioxide and add oxygen
• A blood warmer
• A monitoring device to ensure safe operation of the system

Why Do Children Need ECMO?

There are many diseases that can cause a patient’s heart or lungs to fail. The usual treatments for most of these problems include oxygen delivery, use of a breathing machine (ventilator), medications to help open the lungs or relax the blood vessels between the heart and lungs, and medications to support the heart and blood pressure.

In some cases, the child’s heart or lungs may be too sick to respond to these treatments, and that is where ECMO support can help. A few of the diseases that can be treated with ECMO are listed below:

• Meconium Aspiration Syndrome
• Persistent Pulmonary Hypertension (PPHN)
• Congenital Diaphragmatic Hernia (CDH)
• Acute Respiratory Distress Syndrome (ARDS)
• Status Asthmaticus
• Myocarditis
• Post Cardiotomy Syndrome

Who Is on the ECMO Team?

The ECMO team is made up of many different specialists who work together to provide the best possible care for patients who need ECMO support. In addition to the highly skilled nurses, respiratory therapists, pharmacists, child life specialists, and social workers who are always involved in pediatric care, the following people will be available 24 hours a day to care for patients on ECMO.

• ECMO Doctor – a specially trained physician who will consult with the ICU doctor about special needs of the ECMO machine and patients who need this therapy. The ECMO doctor will oversee the patients care for the entire time the patient is on ECMO.
• Pediatric Surgeon – The pediatric surgeon will be responsible for placing the large catheters (similar to an IV line) that are used to drain the patient’s blood into the ECMO machine and then return it back to the patient. The pediatric surgeon will evaluate the catheters every day, as well as be available for any other surgical issues that may arise.
• Neonatologist and/or Pediatric Intensivist – These are specially trained pediatricians who care for very ill babies and children. This will be the child’s primary doctor while they are in the Intensive Care Unit.
• ECMO Specialist – The ECMO specialist is a nurse or respiratory therapist who has gone through extensive training in order to manage the ECMO machine. There will be an ECMO specialist at the child’s bedside 24 hours a day to maintain the ECMO machine components and follow the necessary laboratory results.
• Advanced Technology Specialist – Advanced Technology Specialists (ATS’s) are ECMO specialists who are also responsible for the set-up and advanced trouble shooting of the ECMO machine. They are also able to set up additional therapies such as continuous renal replacement therapy (CRRT) if needed.