ECMO (Heart & Lung Bypass)
What is ECMO?
When all other forms of conventional life support fail, this modified form of heart and lung bypass known as extracorporeal life support (ECLS) or ECMO is designed to provide temporary support.
ECMO uses 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. While ECMO is not a cure for the underlying cause of cardiac or respiratory failure, it does allow time for recuperation and/or response to conventional therapies. The procedure mechanically supports the patient’s circulation and gas exchange, normally performed by the heart and lungs, thus giving those organs an opportunity to “rest.” As a result, conventional support therapies such as artificial respirators and medications can be decreased to safe, low levels, thus lessening the damage that can occur from support therapies themselves.
What Happens During an ECMO?
- To ensure comfort throughout the procedure, the child receives medication to prevent pain and movement.
- Before the ECMO, a pediatric surgeon places tubes (or cannulas) into large veins and/or arteries located on the right side of the neck, groin or chest. Pediatric surgeons typically use the internal jugular vein and common carotid artery, but other vessels can be used if necessary. A child may have one special cannula placed into the internal jugular vein, depending on the child’s size. This cannula will do the job of the two cannulas.
- Pediatric surgeons typically perform the surgery in the Intensive Care Unit (ICU) but the procedure occasionally takes place outside of the ICU.
Who is a Candidate?
Newborns and older children with either respiratory failure or cardiac failure are treated with this support.
How Does it 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, now oxygen-rich, is then warmed and returned to the child. By doing the work for your child's lungs and/or heart, the process allows the organs time to heal. While a child is on ECMO, he or she is still connected to a ventilator, which keeps the lungs from collapsing until the child gets better.
Throughout the procedure, tests such as chest X-rays, echocardiograms and other blood tests are performed to monitor progress and see if the child’s condition is improving. A particular blood test called an arterial blood gas (ABG) will be done at least twice per day to measure the amount of oxygen present in the blood. As a child's lungs begin to heal, the blood’s oxygen level improves, allowing the medical team to slowly turn down the ECMO in order to “wean” a child's dependence off the machine.
Children on ECMO receive a medicine called Heparin, which keeps children’s blood from clotting in the ECMO circuit. Because Heparin may cause a child to bleed while on ECMO, special blood tests called ACTs are performed every hour to check how fast the blood clots.
Babies remain on ECMO for an average of five days, while older children and some infants may be on ECMO for weeks. The doctor and clinical team determine the length of time needed for children to get better on a case-by-case basis.
What Happens After the Procedure?
When a child is taken off ECMO, the use of Heparin is stopped, and the child’s blood begins to clot normally within a few hours.