Additional ECMO Information
Types of ECMO
VV ECMO: Veno-venous (VV) ECMO takes blood from a vein and returns it to a vein. It is used to support lung function.
VA ECMO: Veno-arterial (VA) ECMO takes blood from a vein and returns it to an artery. VA ECMO supports both the heart and the lungs.
How Is a Patient Placed on ECMO?
The ECMO team and the ECMO physician will place specialized cannula (tubes) into the veins and/or artery to connect the patient to the ECMO circuit. While it is frequently performed at the patient’s bedside, it can also be performed in the Operating Room (OR). The Maimonides ECMO team can also travel to other hospitals to place critically-ill patients on ECMO at those facilities. Before the patient is placed on ECMO, he/she will receive anesthesia to remain comfortable. Once on ECMO, the patient will remain supported by the ventilator.
The ECMO Circuit
Blood flows through the cannulas and is pushed along by the turning motion of the pump. As the blood enters the circuit, it is oxygenated and the carbon dioxide is removed. The blood is then warmed to body temperature and pumped back into the body. The blood will be darker in color when it enters the circuit because it contains insufficient oxygen. Once the blood is pumped back into the body, it will be lighter in color since it will be rich in oxygen. The ECMO team will make adjustments in the level of support that is needed as the patient recovers.
Risks of ECMO
Some risks include bleeding, infection, blood clots, and stroke. Many patients on ECMO will require blood thinners. Blood will be drawn to monitor these levels. Signs of infection are monitored and some patients will require antibiotics. There is also the risk that the initially-affected organ(s) will not recover, despite ECMO support. The ECMO team is specifically-trained to recognize and troubleshoot any issues with the ECMO circuit.
When to Stop Using ECMO
If the patient’s condition improves, the medical team will assess if ECMO can be stopped. When ECMO is stopped, surgery is scheduled to safely remove the cannulas from the body, or they can be removed in the patient’s room. The patient often stays on the ventilator, and different medicines may be used to support heart or lung function. The ventilator will be removed once the patient is able to breathe on his/her own.
While ECMO works well most of the time, it is important to note that there is a possibility that the patient may not respond to treatment. Should this be the case, information will be shared with the family to discuss other forms of treatment.