ECMO- Extra Corporeal Membrane Oxygenation

ECMO 01 1

ECMO- Extra Corporeal Membrane Oxygenation

ECMO stands for Extra Corporeal Membrane Oxygenation. ECMO therapy is used as a last course of action to save a patient’s life. There is a similarity between an ECMO machine and a heart-lung by-pass machine.

A heart-lung by-pass machine is generally used in open-heart surgery. But it is for the short term, just for the surgery.

Whereas in the case of ECMO treatment the patient can be kept on the life support system for three to ten days or depending on how well the patient responds. It is a kind of oxygenation machine.

What is ECMO used for?

ECMO is a life support system and is used as a last resource. It is used to help people whose:

  • Lungs cannot provide enough oxygen to the body, despite using a ventilator.
  • Lungs are unable to get rid of carbon dioxide
  • The heart cannot pump the required blood to the body.
  • To support the people who are waiting for an organ transplant (heart or lungs)

ECMO machine is just ‘buying time’ from God till the time the vital organs like heart and lungs heal themselves or till the time they are transplanted.

ECMO is not a Cure, it is just a Life Support System. It is a kind of oxygenation machine that is much more advanced.

For whom can ECMO be used?

If the patient is on the ventilator and despite that the oxygen levels continue to fall then the patient can be shifted on ECMO-the oxygenation machine.

But we need to check the other conditions before putting the patient on ECMO, like:

  • The patient’s age
  • Other comorbidities
  • Patient’s weight
  • Other prevalent medical conditions.
  • Risk involved

Does ECMO therapy/treatment hurt?

The patient is given sedation while performing the whole procedure so ECMO therapy/treatment does not hurt at all. Even after the cannulas are inserted into the body, the patient is administered medicines to relieve him/her from pain.

In foreign countries, ECMO treatment/therapy is used even on infants and children.

Do all patients who are on ventilators need an ECMO?

NO. As we said earlier, ECMO is the last resource. Only those patients who aren’t responding well on the ventilators can be shifted on the ECMO therapy. While a ventilator assists the lungs to breathe easily, ECMO – an oxygenation machine helps the heart and lungs both to relax.

How does an ECMO machine work?

To make the ECMO machine work, the patient is sedated first. The ECMO machine carries the blood from the patient’s body into the oxidation chamber. Later adds oxygen to it, removes carbon dioxide from it and pumps it again into the patient’s body.

This reduces the load on the heart and lungs because the heart does not have to purify and pump the blood.

It also helps the lungs to recover. It is especially useful in the cases where the lungs cannot provide enough oxygen to the body or where the body is not capable of removing the carbon dioxide from the body.

What procedure is to be followed to connect ECMO with the patient?

The ECMO machine is connected with the veins or arteries of the patient through thick tubes. These tubes are made from plastic and are called ‘cannula’.

These cannulas are attached to a patient’s body through the legs, neck or chest. The process of inserting it into the body is called ‘cannulation’. 

Once the tubes are attached to the body. The next job is of the ‘perfusionist’. The ECMO machine takes blood out from the patient’s body. Later carbon dioxide is removed from it and oxygen is added to it. Subsequently, this blood is pumped into the body.

A perfusionist is an ECMO specialist who knows how much oxygen content is needed and with what force it needs to be pushed into the body.

A patient is connected with cannulas and monitors. The patient is kept in ICCU(Intensive Care and Critical Unit) where he/she is monitored by a perfusionist, cardiologist, neurosurgeon, nephrologist, and cardiac surgeon.

The medical staff that is required for ECMO has special training. The staff along with the perfusionist adjust the pumping speed of the blood, the required amount of oxygen and other vital things.

How is the patient on the ECMO machine monitored?

ECMO machines need to be attended to by various specialists. At Janvi Multispeciality hospital we have the required specialists to deal with complicated cases.

The following things are frequently monitored to keep the patient safe:

  • Heart rate
  • Oxygen levels
  • Blood pressure
  • Measuring carbon dioxide levels in the blood
  • Blood tests to check the viscosity of the blood
  • The temperature of the person and the blood

For how long can the ECMO machine be used?

Generally, the patient is put on the ECMO machine for a week or nine days. In the meantime, efforts are made for heart or lung transplants.

Else, time is borrowed so that both of these vital organs can heal on their own. Sadly, ECMO does not cure but it gives them time and a chance to save the patient.

ECMO definitely improves the survival rate.

ECMO does not save everyone but it has improved survival for many critically ill people who are not responding to usual life support options.

How ECMO helps COVID patients?

Till now we all know how badly COVID affects the lungs. Covid not only affects the lungs but the heart also. COVID affects all five lobes of the lung. It causes patches in the lungs.

Damage of lungs causes problems in breathing and increases breathing rate. This is because carbon dioxide levels increase in the body and the body is unable to get rid of it.

The carbon dioxide remains in the body and causes many problems. The lungs have to work hard and they become stiffer.

Lungs put pressure on the right-hand side of the heart and this causes the heart to fail.

ECMO-an oxygenation machine helps in relieving the pressure from the heart and the lungs. ECMO puts the required oxygen in pulmonary arteries and easily bypasses the lungs and the heart.

What are the two types of ECMO?

The two types of ECMO that we follow are V V ECMO and V A ECMO. V V ECMO stands for Veno-Venous ECMO. It is mainly done for respiratory support.

Whereas V A ECMO is Veno-Arterial ECMO which is done for cardiac support.

The main difference lies in the fact where the oxygenated blood is going to return. In the case of V V ECMO, it returns to the vein whereas in the case of V A ECMO it returns to the arteries.

Are there any risks from ECMO?

ECMO is definitely a life saving, rather than a time borrowing tool. But it too has certain disadvantages.

  • Bleeding due to the blood thinners
  • Infections at the cannulation site.
  • Blood clots
  • Chances of stroke

Does the patient need a ventilator when he/she is on ECMO?

YES! ECMO is purifying the blood outside and pushing it into the body. Whereas a ventilator helps in breathing. Even after removing ECMO, the patient might sometimes need a ventilator.

Should all hospitals have an ECMO machine?

Yes, it is nice if every hospital has it. But as said earlier ECMO machine requires technical know-how to operate it and apart from that it costs more than 50 lakh rupees. So only a few big hospitals like ours can afford to buy it.

At Janvi Multispeciality Hospital we have an ECMO machine. We have the required technical know-how to operate the equipment. We have a detailed case study on ECMO machines that validates this claim. The director of our hospital had to be kept on ECMO for 12 days and he recovered after that. That is why we purchased a costly machine for the benefit of our patients. We don’t wish to leave any stone unturned in the recovery of our patients.

Does your heart still beat on ECMO?

The heart continues to beat during the ECMO treatment but the workload reduces because the heart does not have to pump the blood.

Sources:

American Thoracic Society
https://www.aci.health.nsw.gov.au/