Extracorporeal Membrane Oxygenation (ECMO)

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Dr. Zafar Ahmed

  • MBBS, DNB (Respiratory Diseases)
  • 0 years experience

Dr. Navreet Kaur Sandhu

  • MBBS, , MD
  • 0 years experience

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About Extracorporeal Membrane Oxygenation (ECMO)

ECMO stands for extracorporeal membrane oxygenation. The ECMO machine is very much like heart-lung by-pass machine used in open-heart surgery. It is meant to pump and oxygenate a patient's blood outside the body, enabling the heart and lungs to relax. When a patient is connected to an ECMO, blood flows through tubing to an artificial lung in the machine that adds oxygen and takes out carbon dioxide; then the blood is warmed to body temperature and pumped back into the body.

There are two types of ECMO. The VA ECMO is inked to both a vein and an artery and is used when there are issues with both the heart and lungs. The VV ECMO is connected to one or more veins, generally near the heart, and is employed when the problem is only related to the lungs.

Why and when ECMO is used:

  • For patients recuperating from heart failure, or lung failure or heart surgery.
     
  • As a conduit option to next treatment, when doctors want to examine the state of other organs such as the kidneys or brain before conducting heart or lung surgery.
     
  • For support during high-risk procedures in the cardiac catheterization lab.
     
  • As a bridge to a heart assist device, such as left ventricular assist device (LVAD).
     
  • As a bridge for patients awaiting lung transplant. The ECMO helps keep tissues well oxygenated, which makes the patient a better candidate for transplant.

The Pr ocedure

Being placed on ECMOneeds a surgical procedure but it is generally performed in a patient's room. The patient is totally sedated and provided pain medication and an anti-coagulant to minimize blood clotting. A surgeon, supported by an operating room team, introduces the ECMO catheters into either an artery or veins. An x-ray is then to capture to make sure the tubes isat the right place. Generally 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 checked by especiallyproficient nurses and respiratory therapists, as well as the surgeon and surgical team. Since the patient will be sedated and have a breathing tube in place, supplemental nutrition will be given either intravenously or through a nasal-gastric tube. Nutrition is given either intravenously or through a nasal-gastric tube

While on ECMO, the patient may be given specific medications including: heparin to avoid the creation of blood clots; antibiotics to avert infections; sedatives to lessen movement and improvise sleep; diuretics to help the kidney get rid of fluids; electrolytes to keep the proper balance of salts and sugars; and blood products to substitute blood loss. Discontinuing ECMO requires a surgical procedure to remove the tubes. Multiple tests are generally conducted prior to the termination 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 performed either at the bedside or in the operating room. The doctor will use small stitches to close the spot where the tubes were placed. You will be asleep and monitored for this process. Even though you are off the ECMO, the patient may still need to be put on the support of a ventilator.

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