Reasons for ECMO
ECMO may be used to provide heart and / or lung support for children with a variety of conditions. Children who need ECMO may have one of the following conditions:
- Congenital diaphragmatic hernia
- Pulmonary hypertension
- Congenital heart conditions
- End-state cardiac or respiratory failure
How does ECMO work?
ECMO is similar to the heart-lung bypass machine used in the operating room during open-heart surgery. The ECMO machine can be used for days to weeks. The surgeon places tubes into large blood vessels. These tubes can be placed in the child’s neck, groin or into the chest if your child has had heart surgery. The location will depend on the size of the child and the type of support needed. These tubes, called cannulas, are connected to the ECMO machine. The machine moves blood from your child (extracorporeal) to an artificial lung (membrane). The membrane lung adds oxygen and removes carbon dioxide (oxygenation). It then returns the blood back to you child.
There are two types of ECMO that may be used:
- Veno-arterial (VA) ECMO does the work of both the heart and lungs
- Veno-venous (VV) ECMO does the work of just the lungs.
What to Expect While Your Child Is on ECMO
During the placement of the cannula, your child will be given medicine to make them sleepy and for pain. Once on ECMO, children may be able to wake up and interact with you. If the child becomes restless or does not tolerate being awake, more medicine for pain and relaxation may be given.
Medicines used to support the heart and lungs before ECMO will be slowly turned down and removed as tolerated. The ventilator that has been breathing for your child will also be turned down to allow the lungs to rest.
An ECMO specialist (a nurse or a respiratory therapist) will continuously monitor the ECMO machine and your child while on ECMO. X-rays of the lungs will be done daily to monitor the cannulas and to determine if the lungs are improving. Blood taken from the ECMO machine will be sent to the lab several times a day to help care for your child.
As the heart and lungs improve, the ECMO support will be decreased. This will allow the heart and lungs to do more of the work. Your child will come off ECMO when the heart and lungs have recovered enough to function without the support of the ECMO machine. This can take a few days to several weeks depending on each child’s condition.
Risks and Possible Complications of ECMO
While on ECMO, a medicine called heparin is given. Heparin is an anticoagulant (blood thinner) that is used to help prevent clots from forming in the ECMO machine. Because of the need for heparin, bleeding is the most common risk. Bleeding can occur anywhere, and can be managed in most cases.
Bleeding into the brain is also a possible complication. If this bleeding occurs, ECMO may need to be stopped to control the bleeding.
Small clots can still develop in the ECMO machine. These clots can become dislodged and enter the child’s circulation and possibly cause damage to vital organs.
Infections, kidney failure and failure of the heart to recover adequately are other problems that may be seen during ECMO support.
The ECMO specialist and ECMO clinician will monitor and manage the ECMO machine. They will work closely with the nurse and care team involved with your child’s care.