Extracorporeal Membrane Oxygenation

Extracorporeal membrane oxygenation (ECMO) is a treatment that uses a machine to do the work that the heart and lungs normally do (oxygenator). This treatment may be used:

  • Before an operation to give the heart and lungs time to rest.

  • After an operation to give the body time to heal.

  • In cases of severe illness from disease.

The oxygenator usually is used for a short time. However, it may be used as long as a few weeks.

Blood flows into the oxygenator, which adds oxygen to the blood. This normally is done by the lungs. The blood is warmed. Then, the blood is returned to the body. The oxygenator makes sure the brain, liver, and kidneys get the oxygen they need. When the heart and lungs are ready to work again, the oxygenator is removed.

WHY WOULD MY BABY NEED ECMO?

An oxygenator may be needed for various reasons. They include:

  • Lung problems:

  • Respiratory distress or respiratory failure at birth. This means your baby was born with lungs that do not work right. In cases when ECMO is needed at birth, it is usually reserved for infants born after 34 weeks of gestation.

  • Congenital diaphragmatic hernia. At birth, the divider between the lungs and the organs in the abdomen (diaphragm) has not formed correctly. This malformation allows the organs in the abdomen, include the stomach, liver, and intestines, to push into the chest and against the lungs. When this happens, the lungs cannot work as they should.

  • Meconium aspiration syndrome. This happens when a fetus breathes in fluid that surrounds it in the womb (amniotic fluid) that is contaminated with the fetus' first waste products (meconium) if meconium leaked from the fetus. This can cause the lungs to swell and block the airways.

  • Pulmonary hypertension. Pressure in the lung blood vessels is higher than the pressure of the blood exiting the heart. This problem prevents the lungs from working normally.

  • Pneumonia (lung infection). In severe cases of pneumonia, ECMO may be needed.

  • Heart problems:

  • Heart attack. This may be caused by abnormal heart vessels.

  • Heart failure. The heart cannot pump blood the way it should.

  • Heart surgery. Before or after the operation, ECMO may be needed.

  • Heart transplant (replacing the existing heart with a heart from someone else). Extracorporeal membrane oxygenation may be needed while waiting for a heart to be available. It may also be required after the transplant.

TYPES OF ECMO

The type of ECMO may vary. For example:

  • Venoarterial ECMO. This helps both the heart and the lungs. Blood is taken out of the body as it returns to the heart through the veins. The tube that takes out the blood is called a cannula. The blood is oxygenated and pumped back into body through an artery.

  • Venovenous ECMO. This type of ECMO helps only the lungs. The cannula is put in a vein to remove blood. The blood is oxygenated and returned to the body in the same vein. The oxygenated blood flows into the heart, which pumps it out to the body.

WHAT WILL HAPPEN WHEN YOUR BABY RECEIVES ECMO

  • The oxygenator will be right next to your baby's bed. Your baby will be watched very closely by a team of caregivers.

  • Your baby must be very quiet and not move very much to avoid changing the cannula position. However, you can still talk to and touch your baby.

  • Medications. Medications will be given through one or more intravenous (IV) access tubes. A needle will be put in one of your baby's blood vessels. This is connected to a plastic tube. Medicines flow into the body through the IV tube.

  • An anesthetic (medication to keep your baby asleep) will be given when your baby is hooked up to the oxygenator. This means your baby will feel nothing when the cannula is put in.

  • A medication to prevent blood from clotting will be given to your baby.

  • A sedative (medication to help your baby relax) will probably be given.

  • Pain medicine usually is given, too. This keeps your baby comfortable.

  • Medications may be used to treat an infection or lower blood pressure.

  • Testing.

  • Blood tests and X-ray exams may be done. Echocardiography (an echo bounces sound waves off the chest) also may be done. An ultrasound exam of the head may be done to detect bleeding into the brain. The tests often are done more than once.

  • Tiny monitors will be put on the baby's body. These are used to check your baby's heartbeat, oxygen level, and blood pressure.

  • Breathing help. Your baby's lungs do not add oxygen to the blood when the oxygenator is used. But, the lungs still need to be supported.

  • A breathing tube will be put through your baby's nose or mouth. This keeps the air passage open.

  • A breathing machine (ventilator) may be used. It keeps the lungs inflated, like blowing air into a balloon.

  • Feeding. The baby cannot eat normally during ECMO.

  • Nutrition will be delivered through one of the IV tubes. Sometimes a small amount of nutrition may be given through a tube inserted directly in your baby's stomach.

  • Mothers who breastfeed may want to pump their breast milk in advance so it can be saved for when the baby is taken off the oxgynator.

RISKS AND COMPLICATIONS

The longer the oxygenator is used, the more likely it is that problems will develop. Problems may include:

  • Bleeding.

  • It is important to keep blood clots from forming. These are clumps that can block the flow of blood. Your baby will probably be given a medicine that helps prevent clotting. These drugs are sometimes called blood-thinners. Your baby may bleed more when taking a blood-thinner.

  • Bleeding may occur through the skin. This might be where the cannula goes in or where the IV or catheters go in.

  • Bleeding also may occur inside the body. The most dangerous place for bleeding to occur is in the brain.

  • The baby's caregivers will adjust the amount of blood-thinner to prevent too much bleeding.

  • Infection. The risk for infection is raised because of the multiple tubes placed in the child.

  • Reactions to blood transfusions (replacing your baby's blood with blood from someone else). Reactions include damage to the child's kidneys, liver, brain, heart, or other organs.

  • Problems with the ECMO machine.