Medical Specialties

ECMO: What is it?

Phoenix Children's was the first children's hospital in Arizona to offer the Extracorporeal Membrane Oxygenation program (ECMO) and the 32nd among all hospitals. Since the start of Children’s program in 1987, more than 420 infants and children have received treatment.

Newborns, older children, and adults with either respiratory failure or cardiac failure are treated with this support. In the newborn population, the survival rate is as high at 95 percent for infants with meconium aspiration syndrome.

What is ECMO?

ECMO

Extracorporeal life support (ECLS), or ECMO, is a modified form of heart and lung bypass that is designed to be used as temporary support for patients who are failing all other conventional methods of life support.

ECMO involves the use of a modified cardiopulmonary bypass circuit for temporary life support of patients with potentially reversible cardiac and/or respiratory failure. ECMO provides the mechanism for gas exchange while bypassing the heart and lungs.

ECMO is not a cure for the underlying cause of the cardiac and /or respiratory failure. However, it allows time for recuperation and/or response to more conventional therapies. With circulation and gas exchange supported mechanically, the heart and lungs are not needed for life support and are allowed to “rest”. This means that conventional support therapies such as artificial respirators and medications can be decreased to safe, low levels lessening the damage that can occur from support therapies themselves.

What to expect with ECMO

There are two types of ECMO: Venoarterial (VA) and Venovenous (VV). VA ECMO uses an artery and a vein. While venovenous (VV) ECMO, uses one or two veins. The doctor decides which type your child needs.

When a child goes on ECMO, the following things happen:

  • Before ECMO can begin, a pediatric surgeon places tubes (or cannulas) into large veins and/or arteries located on the right side of the neck, groin or chest. The number of tubes used depends on the type of ECMO you child needs. The most commonly used vessels are called the internal jugular vein and the common carotid artery. Although, other vessels can be used if necessary to support your child. Your child may have one special cannula placed into the internal jugular vein, depending on how big your child is. This cannula will do the job of the two cannulas.
  • Your child’s comfort is very important. Prior to any surgical procedure your child will be given medications to prevent pain and movement during the surgery. Various types of medications will be given to your child to ensure their comfort.
  • The surgery will typically happen in the Intensive Care Unit (ICU) but, occasionally will take place outside of the ICU.

How does ECMO work?

The ECMO machine is made up of several parts: a pump, an artificial lung, a blood warmer and various monitoring components. The ECMO machine takes blue blood (without oxygen) out of the right side of the heart and pumps it through the artificial lung (oxygenator). The blood is now red blood (with oxygen). This blood is then warmed before it is returned to the child - as illustrated in this example below.

heart ECMO

The ECMO machine does the work for your child's lungs and/or heart and allows them time to heal. During the time your child is on ECMO, he or she is still connected to the ventilator. The ventilator is used to keep the lungs from collapsing while your child gets better.

At the beginning of the procedure, the ECMO machine does most of the work for the child's heart and/or lungs. Even though your child looks much better, it is important to remember that the ECMO machine is doing the work the lungs can't do on their own.

Monitoring and testing are key steps

To see if your child is getting better, we will perform several tests such as chest x-rays, echocardiograms and other blood tests to monitor their progress. One particular blood test referred to as an arterial blood gas (ABG) will be done at least twice per day to check to see how much oxygen is present in the blood. As your child's lungs begin to heal, the oxygen level in the blood improves. This allows us to turn down the ECMO slowly in order to “wean” your child's dependence off the machine.

 

ECMO

 

The machine is turned down until it is doing only a small portion of the work referred to as “idle flow”. At this time, we may try to take your child off ECMO and measure the level of oxygen and carbon dioxide in the blood to see if the lungs are ready to work on their own.

 

While your child is on ECMO, he or she receives a medicine called Heparin, which keeps your child's blood from clotting in the ECMO circuit. Heparin may cause your child to bleed while on ECMO. Special blood tests called ACTs are done every hour to check how fast the blood is clotting.

 

When your child is taken off ECMO, the use of Heparin is stopped, and the time it takes your child's blood to clot will return to normal within a few hours.

Length of time on ECMO

Babies are on ECMO for an average of five days. Older children and some infants, however, may be on ECMO for weeks. The doctor and clinical team determine how long it should take for your child to get better, however, the time needed to recover is not always known.

ECMO Referrals / Contact Us

To refer a patient for ECMO, please contact:

602-478-5550 (PICU)

602-245-0649 (CVICU)

602-546-1454 (NICU)

For general information, please call Alicia Schmidt or Diane DePietro at (602) 546-1448.

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