To help ensure the best outcomes, it's important to choose an experienced and qualified ECMO team with rigorous training in this complex level of life support. While your child is on ECMO at Children's Hospital of Philadelphia, they will be cared for by a team of pediatric surgeons, cardiac surgeons, neonatologists, intensivists, cardiologists, perfusionists, nurses, respiratory therapists and other specialists.
A specially trained attending pediatric surgeon will perform the operation to insert the cannulas at the start of ECMO and will remove them when treatment is finished. Additionally, there are more than 25 nurses and respiratory therapists trained as bedside ECMO specialists. They will constantly monitor vital signs and comfort, perform care and maintain the ECMO circuit. That person may be the program manager, a Core Team member or a perfusionist for cardiac cases.
A team of doctors will make rounds visit the bedside every morning, assess the progress of your child, and share that information with you.
Doctors will also check on your child throughout the day. In addition, a wide range of specialists are on-call at all times. Learn more about what sets our team apart in providing the best care for your child on ECMO. Your child will have one or more large plastic tubes, called cannulas, inserted into large blood vessels, most often in the neck. A surgeon places the tubes while your child is under anesthesia. These cannulas provide access directly into the heart and are needed for ECMO to work.
Our team will request your consent before performing these operations. Every baby on ECMO receives blood products we will ask you to sign a consent for this, too.
The blue cannula takes de-oxygenated blood, which has circulated through the body, out of the heart and into the ECMO machine, which adds oxygen to it. Blood that has been oxygenated by the ECMO machine is pumped into the aorta through the red cannula. The aorta is the large blood vessel that normally carries oxygenated blood out of the heart to the rest of the body.
Image shows the anatomy of a baby with congenital diaphragmatic hernia. The organs are shown to illustrate where the ECMO cannulas go. Even though ECMO does most of the work for the lungs, your child will remain on a breathing machine to deliver controlled amounts of pressure and oxygen to his lungs.
The machine also allows the body to get rid of carbon dioxide, usually expelled when you exhale. The breathing tube inserted in the nose or mouth that connects the lungs to the breathing machine is called an endotracheal tube ET tube. Your child will also continue to need tubes and lines as she did before receiving ECMO.
Your child may also have a chest tube placed into the chest through the chest wall to drain air or fluid outside the lungs. Your child will receive medication to treat any pain or discomfort while on ECMO. But in an effort to save more lives, UCSF physicians have begun using the technology earlier and with a broader range of patients than in the past. Learn more. Being placed on ECMO requires a surgical procedure but it is usually done in a patient's room. The patient is sedated and given pain medication and an anti-coagulant to minimize blood clotting.
A surgeon, assisted by an operating room team, inserts the ECMO catheters into either an artery or veins. An x-ray is then taken to ensure the tubes are in the right place. Usually a patient on the ECMO pump will also be on a ventilator, which helps the lungs to heal.
While on ECMO, the patient will be monitored by specially trained nurses and respiratory therapists, as well as the surgeon and surgical team. Since you will be sedated and have a breathing tube in place, supplemental nutrition will be provided either intravenously or though a nasal-gastric tube. Nutrition is delivered either intravenously or though a nasal-gastric tube.
While on ECMO, you may be given certain medications including: heparin to prevent blood clots; antibiotics to prevent infections; sedatives to minimize movement and improve sleep; diuretics to help the kidney get rid of fluids; electrolytes to maintain the proper balance of salts and sugars; and blood products to replace blood loss.
Discontinuing ECMO requires a surgical procedure to remove the tubes. Multiple tests are usually done prior to the discontinuation of ECMO therapy to confirm that your heart and lungs are ready.
Once the ECMO cannulas are removed, the vessels will need to be repaired. This can be done either at the bedside or in the operating room.
The doctor will use small stitches to close the spot where the tubes were placed. In extracorporeal membrane oxygenation ECMO , blood is pumped outside of your body to a heart-lung machine that removes carbon dioxide and sends oxygen-filled blood back to tissues in the body. Blood flows from the right side of the heart to the membrane oxygenator in the heart-lung machine, and then is rewarmed and sent back to the body. This method allows the blood to "bypass" the heart and lungs, allowing these organs to rest and heal.
ECMO is used in critical care situations, when your heart and lungs need help so that you can heal. ECMO may be used to help people who are very ill with conditions of the heart and lungs, or who are waiting for or recovering from a heart transplant. It may be an option when other life support measures haven't worked.
ECMO does not treat or cure a disease, but can help you when your body temporarily can't provide your tissues with enough oxygen. Some heart conditions in which ECMO may be used include:. Some lung pulmonary conditions in which ECMO may be used include:. The most common risks that may occur with ECMO include:. ECMO is used when life support is needed after surgery, or when you are very ill and your heart or lungs need help so that you can heal.
Your doctor will decide when it may be helpful. If you need ECMO , your doctor and trained respiratory therapists will prepare you. Your doctor will insert a thin, flexible tube cannula into a vein to draw out blood and a second tube into a vein or artery to return warmed blood with oxygen to your body. You will receive other medications, including sedation, to make you comfortable while receiving ECMO , and may not be able to talk during this time.
Depending on your condition, ECMO can be used for a few days to a few weeks.
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