• Rukmani Birla Hospital,Gopalpura Bypass Road, Near Triveni Bridge,Gopalpura,Jaipur – 302018.

WHAT IS ECMO TREATMENT?

ECMO is an acronym for extracorporeal membrane oxygenation, which is a life-saving procedure to support patients that have fatal diseases or health conditions affecting mostly the heart or lungs. In this treatment, oxygen is pumped into the blood from outside the body, which allows the heart and lung to rest in the meantime. ECMO provides advanced breathing and heart assistance for a long period and is tapped as a last resort when all other forms of treatment have failed to improve the condition of the patient or deliver any positive results.

ECMO stands for:

  • Extracorporeal implying outside the body
  • Membrane signifying an artificial lung
  • Oxygenation refers to the process of supplying oxygen in blood

Procedure of ECMO

In an ECMO, the patient’s blood flows through a tube into an artificial lung kept in a machine; upon reaching the lung, the blood is cleaned of carbon dioxide and enriched with oxygen. After this, the temperature of the blood is restored to normal warm and is then pumped inside the body through the tube. This procedure is supported by a heart-lung bypass machine which is similar to the one used in an open-heart surgery. The ECMO machine is also known as ‘circuit’ is large and contains tubes made of sterile plastic that help the blood flow from the patient to the artificial lung and then back into the patient.

Requirement of ECMO

ECMO is an advanced life-threatening technique which is used in critical cases such as below:

  • Patients recovering post a heart or lung failure
  • Patients recovering post a heart surgery
  • Assessing the underlying condition and the state of organs such as kidneys and brain before conducting a surgery
  • Assisting high risk operations
  • Supporting a heart assist device
  • Assisting patients in need for a lung transplant since ECMO helps to keep the tissues oxygenated, improving chances of the patient for a transplant

Procedure of ECMO

To begin the ECMO procedure, the patient is given anaesthesia, pain medication and medication to prevent blood clotting. Post this, the surgeon places an ECMO catheter into the vein or artery or both, as per the need of the patient and the health condition. Once the catheter is inserted in the vein or artery, an X-Ray is taken to check if the tubes are placed in the right position. When the patient is placed on the ECMO, the condition is closely monitored by specialised nurses, respiratory therapists, the concerned surgeon and surgical team. In an ECMO, supplemental nutrition is provided to the patient through intravenous methods or a nasal-gastric tube.

To avoid any complications due to ECMO, the doctor will administer some targeted medications that will help prevent blood clotting and infections. These medicines also help to minimise movement and ensure the patients is rested well and gets the required sleep. Additionally, diuretics will be included to enable the kidney to flush out the fluid; electrolytes will be suggested to ensure there is appropriate balance of salt and sugar in the body; and other medicines will be recommended to help with blood loss.

In an ECMO procedure, the machine will take out the oxygen-less blood from the body and transfer it via tubes to the artificial lungs known as Oxygenator. When the blood is transferred to the artificial lung, these lungs enrich it with oxygen and remove all carbon dioxide from it. This causes the blood to change its colour from dark to bright red. When the blood is enriched with oxygen, the machine then warms the blood to match its temperature with the body; once this is done, the new enriched blood is pumped back into the body. This will allow the lung and heart to rest, while their functions are performed artificially outside the body.

Once the purpose of the ECMO treatment is solved and the health condition is stabilised, the tubes attached to the body are removed via a surgical procedure. However, ECMO is discontinued only after receiving clearance from multiple tests and reports that must state that the patient’s natural heart and lung are healthy and can effectively perform their set functions. Post the tubes are removed; the vessels are repaired by minor stitches that aim to close the openings where the tubes for the ECMO were placed. However, even after the patient is off ECMO, they may require to be supported by a ventilator depending on recovery and condition.

Risks of ECMO

ECMO is otherwise a very safe method and serves it purpose with all honesty. However, it does involve some rare risks such as below:

  • Bleeding because of the blood clot prevention medications
  • Infection at the site of entry of the tubes
  • Blood transfusion issues
  • Formation of small clots or air bubbles in the tubes
  • Higher chances of stroke
  • Swelling

Besides, ECMO can also cause emotional trauma in some patients but is by far the best method to support the heart and lungs and enable quick healing.

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