ECMO may be initiated in the operating room immediately after an operation, in the cath lab or in the intensive care unit (ICU).
When initiated in the operating room, the tubes (cannulas) connecting the patient to the ECMO circuit are generally placed directly into the large blood vessels adjacent to the heart, similar to the connections made during open heart surgery.
When ECMO is begun in the intensive care unit, the tubes are usually placed via blood vessels at the base of the neck. This procedure can take place at the bedside in the intensive care unit.
Typically, a small incision is made along the right side of the neck. One cannula is placed in a large vein in the neck leading to the right atrium of the heart.
Another cannula is placed in a large artery (carotid artery). The cannulas are then connected to the tubing of the ECMO machine and bypass circulation is begun.
Blood drains from the right side of the heart through the venous tubing and is pumped through the membrane oxygenator (artificial lung), which takes over the work of the baby's lungs. The blood is then rewarmed and returned to the body through the arterial cannula.
This oxygen-enriched blood is carried throughout the body, supplying the brain, heart, kidneys, and all other vital organs and tissues.
As the heart improves, the amount of blood flow through the ECMO circuit can be decreased, allowing the heart to do more of the work.
- The doctors who have been caring for the child will decide if ECMO is needed. They will discuss this with you, as well as the ECMO physicians.
- When placing the cannulas, a local anesthetic is used at the site as well as strong anesthetic medicines given through an IV.
- Once on ECMO, children may be allowed to wake up and interact. This allows caregivers the ability to monitor neurologic status. If the child becomes restless, more medicine for pain and relaxation will be given.