ECMO Extracorporeal Membrane Oxygenation What Is ECMO? An ECMO (extracorporeal membrane oxygenation) machine is used only after medicine and a breathing machine (ventilator) have failed to make your loved one better. It allows the lungs and/or heart to rest and heal while doctors treat your loved one’s underlying illness that is causing heart and/or lung failure. During ECMO, patients appear to be better, but you need to know that the person is still very sick. Your loved one needs the ECMO machine for life support. The ECMO machine works for the heart and lungs. It is similar to the heart/lung machine used in open-heart surgery. When your loved one is placed on ECMO, blood will flow through the ECMO tubing where it receives oxygen from the machine’s lung. This happens until the heart and/or lungs are able to work on their own. We know that all of this is very stressful for families. Please ask questions and talk with us about any concerns you may have concerning your loved one’s care. As you think of things, write them down and speak with your nurse or provider. Types of ECMO There are two types of ECMO: VA and VV. The terms VA and VV refer to the blood vessels used in the treatment. In VA ECMO, a tube is placed in both a vein and an artery. VA is used when there are problems with both the heart and lung. It helps the heart and lungs to rest and get better. In VV ECMO, one or more tubes are placed in a vein. VV is used when there are lung problems only. Sometimes, a person may start on VV and need to be switched to VA. What Are the Risks of ECMO? Your doctor will discuss these risks with you. Bleeding may occur because the blood must be kept from clotting in the tubing. A drug called heparin is given to prevent clots. Sometimes this can lead to bleeding. Some bleeding is normal. The amount of heparin will be watched closely, and steps will be taken to slow any bleeding that happens. If the bleeding increases, your loved one may need surgery. If the bleeding gets too great, ECMO may need to be stopped. There is no way to find out if your loved one has had any damage to the brain from low levels of oxygen before ECMO. If this has happened, there may be an injured area that bleeds when heparin is used. These patients may have more problems. Infection: This is a risk any time a tube is placed in the body, especially a blood vessel. We will watch closely for signs for infection. Antibiotics will be given if needed. Transfusions: A person on ECMO will need blood products. The blood used from the blood bank is checked for both hepatitis and AIDS; however, no test is 100 percent accurate. When blood is given there is a risk of side effects. In most cases, this can be managed with medicine. Small clots or air bubbles can get into the blood from the tubes. Sometimes this can cause injury to other parts of the body, and if severe they can be fatal. Many safety measures are taken so this won’t happen. While we wish it could, ECMO therapy does not help everyone, and death can occur. Be assured that the ECMO staff is well trained. They are very at ease with the machines and emergencies. In most cases, your loved one’s risk of dying without ECMO is greater than the risk of dying with it. Don’t be afraid to ask questions. Test before ECMO Placement The doctor will order many lab tests and X-rays before ECMO starts. These tests may also be done during ECMO, some of them are: CAT Scan of the head- looks at the brain Chest X-ray - looks at the lungs and the location of tubes in the chest Blood gases (ABG) - to check the oxygen and carbon dioxide levels in the blood Echocardiogram - an ultrasound to “look” at the heart and how well it works How Is a Person Placed on ECMO? If your loved one needs ECMO, the doctor will talk with you. You will be told of the risks of ECMO. A specially trained surgeon, along with an operating room team, will place the tubes. This may take place in the operating room or at the bedside. Before surgery starts, medicines will be given through an IV to prevent any pain and make them very sleepy. Your doctor or nurse may refer to medicine as “paralysis” or “muscle relaxant” medicine to prevent your loved one from moving during the surgery and during ECMO. In VA ECMO, one tube will be placed in a large vein and another in an artery. In VV ECMO, one tube is placed in a large vein, but sometimes two tubes are needed. These tubes are then hooked to the ECMO machine. An X-ray will be taken right away to make sure the tubes are in the right place. A person on the ECMO machine (pump) will remain on the breathing machine (ventilator). This will make it easier to remove fluids from the lungs and to give small breaths to keep the lungs working and help them heal. Weaning from the ECMO Machine Coming off ECMO is done when the heart and/or lungs are better. A weaning or a trial off will let us know if the lungs are able to work and put oxygen in the blood. The speed of the blood flow through the ECMO pump is decreased, and help with the breathing machine is increased. The blood still flows through the ECMO. If your loved one is off ECMO, a breathing machine is still needed until he or she gets better. The amount of time it takes to come off the breathing machine varies. Nutrition While on ECMO, your loved one will receive all nutrition needed for energy and healing through an IV or will be fed through a tube placed in the nose or mouth that goes to stomach. Visiting Family plays an important part in recovery. While on ECMO, there are some things you can do to help: Bring photographs. Touch your loved one and talk to them. If you are afraid to touch your loved one, ask the nurse or ECMO specialist for help. Bring music or relaxation tapes. Take care of yourself. Eat well and get plenty of rest. Getting sick yourself will not help either of you. Children can draw or color pictures to be placed bedside. Call at any time, day or night, to check on your loved one. We are always happy to talk to you and answer questions.