Eternal Hospital is a multidisciplinary healthcare facility that provides advanced cardiac and critical care services supported by experienced doctors, nurses, respiratory therapists, perfusionists, surgeons, and other healthcare professionals. ECMO is an advanced form of temporary life support that may be considered for carefully selected patients with severe heart or lung failure when conventional treatments are not providing adequate support.
ECMO care requires continuous monitoring and coordinated management. The treatment may support a patient while the underlying condition is treated and the heart and lungs are given an opportunity to rest and recover.
What is Extracorporeal Membrane Oxygenation (ECMO)?
Extracorporeal Membrane Oxygenation (ECMO) is a form of advanced life support that temporarily supports the function of the heart, lungs, or both. The term “extracorporeal” means that the blood is circulated outside the body through an ECMO circuit.
During ECMO, blood is withdrawn from the patient's body through large cannulas. It passes through a pump and a membrane oxygenator, which adds oxygen to the blood and removes carbon dioxide. The blood may then be warmed and returned to the patient's circulation.
ECMO does not cure the underlying disease. Instead, it provides temporary support while healthcare professionals treat the condition responsible for severe heart or respiratory failure.
Who may benefit from ECMO?
ECMO may be considered for patients with life-threatening heart or lung conditions when the heart or lungs cannot adequately perform their normal functions. Depending on the patient's condition, ECMO may be used to provide temporary support while doctors treat the underlying illness.
Conditions in which ECMO may be considered include:
- Acute respiratory distress syndrome (ARDS)
- Severe respiratory failure
- Cardiogenic shock
- Heart attack
- Myocarditis
- Cardiomyopathy
- Pulmonary embolism
- Severe pneumonia
- Sepsis
- Influenza and certain severe infections
- Pulmonary hypertension
- Severe trauma
- Hypothermia
- Severe allergic reactions
- Selected patients before or after heart or lung transplantation
ECMO may also be considered in certain emergency situations, including cardiac arrest, when appropriate medical criteria are met.
What are the types of ECMO?
There are two commonly used forms of ECMO: veno-arterial (VA) ECMO and veno-venous (VV) ECMO.
Veno-Arterial (VA) ECMO
VA ECMO can provide support for both the heart and lungs. Blood is drained from a large vein, passes through the ECMO circuit where oxygen is added and carbon dioxide is removed, and is then returned to the body through an artery. It may be considered when the heart cannot pump enough blood to meet the body's needs.
Veno-Venous (VV) ECMO
VV ECMO primarily provides respiratory support. Blood is removed from a vein, oxygenated through the ECMO circuit, and returned to the venous circulation. The patient's heart must continue to provide sufficient circulation. VV ECMO may therefore be considered for severe respiratory failure when cardiac function remains adequate.
The ECMO team determines the appropriate configuration based on the patient's condition and the level of heart and lung support required.
What happens during ECMO treatment?
ECMO begins with the placement of large, flexible tubes called cannulas into suitable blood vessels, commonly in the neck, chest, or groin. The cannulas connect the patient's circulation to the ECMO circuit.
A pump moves blood through the circuit, while the membrane oxygenator performs gas exchange by adding oxygen and removing carbon dioxide. A heat exchanger may warm the blood before it returns to the body.
Patients may receive medicines for pain control, sedation, anxiety, and anticoagulation. Some patients may remain sedated, while selected patients can become awake and communicate during ECMO under close medical supervision.
Throughout treatment, the ECMO team monitors blood gases, circulation, heart and lung function, laboratory results, and the ECMO circuit.
What are the potential benefits of ECMO?
ECMO provides temporary support when the heart or lungs are unable to maintain adequate oxygenation or circulation. By taking over some of the work normally performed by these organs, ECMO can provide time for the underlying condition to be treated.
Potential benefits include:
- Improved oxygen delivery to vital organs
- Removal of excess carbon dioxide
- Temporary support for severe heart failure or respiratory failure
- Reduced workload on the heart and lungs
- Support while the underlying illness is treated
- Stabilisation while evaluating treatment options
- Support before or after selected heart or lung transplants
The expected benefit varies considerably depending on the underlying disease, severity of organ failure, duration of illness, and overall health.
What are the risks of ECMO?
ECMO is a major life-support treatment and carries potential complications. Patients require continuous monitoring because both the treatment and the underlying critical illness can create significant risks.
Possible complications include:
- Bleeding
- Blood clots
- Stroke
- Infection
- Limb ischemia or reduced blood flow to an extremity
- Kidney injury or kidney failure
- Seizures
- Damage to organs from inadequate circulation
- Problems involving the ECMO circuit
- Air entering the circuit
- Device malfunction
Anticoagulant medicines such as heparin are commonly used to reduce clot formation within the ECMO circuit. However, anticoagulation can also increase the risk of bleeding, including potentially serious bleeding.
How long does ECMO treatment last?
The duration of ECMO varies according to the patient's condition and response to treatment. Some patients may require ECMO for hours or days, while others may need support for several weeks. In selected circumstances, longer periods of support may be required.
The ECMO team evaluates the patients progress regularly. Blood tests, vital signs, imaging, heart function, lung function, and other clinical findings help determine whether the patient is ready for reduced ECMO support.
What happens when a patient comes off ECMO?
When the underlying condition improves and the heart and/or lungs can provide sufficient function, the medical team may begin weaning ECMO support. Support is gradually reduced or temporarily tested to determine whether the patient can maintain stable circulation and oxygenation without the machine.
Once the team determines that ECMO is no longer required, the cannulas are removed and the insertion sites are carefully closed and monitored for bleeding.
Recovery does not necessarily end when ECMO is discontinued. Patients may continue to require ventilator support, medications, nutritional support, physiotherapy, occupational therapy, and intensive rehabilitation. Recovery time depends on the severity of the original illness and the patient's overall condition.
Why choose Eternal Hospital for ECMO care?
ECMO treatment requires specialised equipment, experienced professionals, intensive monitoring, and coordinated decision-making. Comprehensive ECMO care may involve critical care physicians, cardiologists, cardiothoracic surgeons, perfusionists, ECMO specialists, nurses, respiratory therapists, rehabilitation professionals, and other specialists.
At Eternal Hospital, Jaipur, a multidisciplinary approach can support patients throughout the ECMO journey, including assessment, cannulation, intensive care, monitoring, treatment of the underlying condition, weaning, decannulation, rehabilitation, and ongoing recovery.
