Guide to Extracorporeal Membrane Oxygenation (ECMO)

Key Info

  • Extracorporeal Membrane Oxygenation (ECMO) is an external life support system that temporarily supports or replaces the function of the heart and/or lungs to keep the body appropriately supplied with oxygenated blood.
     
  • ECMO is used in patients presenting a wide variety of critical heart or lung conditions. When other forms of treatment have failed, ECMO supports patients until recovery, or while awaiting an organ transplant.
     
  • ECMO requires an experienced, multidisciplinary team to successfully manage patients while they receive treatment.

What does ECMO do?

In a healthy person, the heart pumps blood through the lungs, where blood is oxygenated and carbon dioxide is removed. The oxygen-rich blood is then pumped through the circulatory system to the rest of the body.

Extracorporeal membrane oxygenation (ECMO) is an external life support system that temporarily supports or replaces the function of the heart and / or lungs when these organs are injured or failing, despite optimized medical management.

ECMO supports the patient’s heart and lungs while the care team assesses their condition and treats the underlying disease. The patient will be supported until the heart or lungs recover. 

If a patient’s heart or lungs are too damaged to recover and they are deemed appropriate candidates for organ transplant, ECMO can be used as a bridge while the patient awaits transplantation.

Who Needs ECMO?

ECMO is used in many serious heart and/or lung conditions to support the patient when optimized medical management has failed. Some conditions that may require ECMO support include:

  • Acute respiratory distress syndrome (ARDS)
  • Asthma
  • Pneumonia (lung infection)
  • Respiratory viral diseases like flu and COVID-19
  • Cardiac arrest (heart stops beating)
  • Cardiogenic shock (heart does not pump well enough)
  • Cardiomyopathy (disease of the heart muscle)
  • Myocarditis (infection or inflammation of the heart)
  • Post-transplant complications (heart or lung transplant)
  • Pulmonary embolism (blood clot in the lungs)
  • Pulmonary hypertension (elevated pulmonary blood pressure)
  • End-stage heart or lung failure prior to transplantation
  • Support after heart or lung surgery
  • Trauma

How does ECMO work?

ECMO procedures are most frequently performed at the bedside, when the patient is asleep. During the process:

  • A surgeon will place one or more tubes (called cannulas) in large blood vessels of the neck, leg, or chest. The location of the cannulas determines the type of support delivered.
  • These cannulas are connected to the ECMO device that includes a pump and a membrane that allows oxygen to be added to the blood while carbon dioxide is removed.
  • The oxygenated blood is then reinfused into the body.
  • A blood thinning medication is frequently used to prevent blood clots.
  • The patient is admitted in the intensive care unit where daily care and ECMO management occurs in a highly skilled and monitored environment.
  • The ECMO machine can function for as long as needed to help the patient recover.

Next, the team proceeds with the appropriate diagnostic tests and implements the best evidenced treatments, monitors patient support and tracks recovery. As the heart and lungs heal, ECMO support is gradually and carefully weaned. Eventually, ECMO is removed when the heart or the lungs have shown appropriate recovery.

What are the Types of ECMO?

There are two main types of ECMO, depending on the condition being treated and the patient's overall health. Variations around these support modes are possible depending on the patient’s needs.

Veno-Venous (V-V) ECMO

V-V ECMO is used when the lungs aren’t working, but the heart can still function well. V-V ECMO allows the lungs to rest and heal.

Veno-Arterial (V-A) ECMO

V-A ECMO is used when the heart, or both the heart and lungs, need support.

What are the Risks for ECMO

ECMO is a complex treatment that carries some risk to the patient. The most common risks associated with ECMO include:

  • Bleeding
  • Blood clots
  • Infection
  • Poor circulation in extremities (hands, legs, or feet)
  • Seizures
  • Stroke

How Long Can Someone Be On ECMO?

The amount of time a person can remain on ECMO depends on the disease severity and overall underlying health (which dictates the capacity to recover). Treatment can last from a few days to a few weeks. When the injured heart or lungs recover enough to support the patient without assistance, ECMO is removed.

Are People Awake While on ECMO?

During the ECMO process, patients receive medications to make them comfortable. When possible, patients can be awake while on ECMO and receive medications to make sure they are not in pain.

In some cases, particularly when ECMO is used to bridge patients to heart or lung transplant, the goal is to keep patients awake, talking, and mobile.

Current research suggests that walking and moving while on ECMO improves recovery after the transplant. 

Does ECMO Hurt?

No, the ECMO cannulation procedure is performed under anesthesia, and patients receive pain medication and sedatives to help them relax or sleep. Once supported on ECMO, comfort is evaluated on a routine basis. For patients who cannot communicate, the ECMO team is trained to watch for signs of discomfort and address them immediately.

Who is Part of the ECMO Team?

ECMO is a highly specialized treatment that requires a multidisciplinary team of physicians and other medical providers, including:

  • Anesthesiologists
  • ECMO and transplant surgeons
  • Intensive care specialists
  • Cardiologists
  • Pulmonologists
  • Hematologists
  • Nephrologists
  • Infectious disease specialists
  • Specialized and dedicated ECMO nurses
  • Specialized nurse practitioners or physician assistants
  • Physical therapists
  • Perfusion specialists
  • Respiratory therapists
  • Critical care pharmacists
  • Rehab specialists
  • Psychologists, social workers and chaplains

In addition to the ECMO care team, families have access to helpful resources and support, including social workers and chaplains who have experience working with ECMO patients.

Is ECMO a Cure?

ECMO is not a cure; it is only intended to temporarily support the heart and/or lungs until recovery. ECMO is reserved for critical health issues, and it is possible that the heart or lungs may not recover while on ECMO. However, ECMO gives the sickest patients a chance to recover when other treatments have failed.

Next Steps

If you need help for a lung or chest issue, we’re here for you. Call (212) 305-7771 or request an appointment online to get started today.

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