ECMO Treatment, ECMO Therapy

Overview

ECMO (extracorporeal membrane oxygenation) is a complex system, similar to the heart-lung bypass machine used in open heart surgery. When a patient is connected to ECMO, blood flows through tubing to an artificial lung in the machine, which adds oxygen and takes out carbon dioxide. Thereafter, the blood is warmed as per the body temperature and pumped back in the body.

ECMO Therapy is a high end rescue therapy for patients suffering from heart and lung failure but are neurologically intact. The technology provides support during high-risk procedures in the cardiac catheterization lab after a serious heart attack. It acts as a bridge for patients awaiting lung transplant. The ECMO helps keep the tissues well oxygenated, thereby making the candidate suitable for a transplant. When a patient is connected to ECMO, blood flows by tubing an artificial lung in the machine, which adds oxygen and takes out carbon dioxide.

ECMO pumps and oxygenates the impure blood outside the body, allowing the heart and lungs to rest. The impure blood then passes through the ECMO machine and purifies it. Thereafter, it sends the blood back to the body through complex system of channels.

There are two types of Extra Corporeal Membrane (ECMO)

VA ECMO is connected both to a vein and an artery and is used when there are problems with both heart and lungs.
The VV-ECMO is connected to one or more veins, usually near the heart, and is used when the problem is only in the lungs. This machine is primarily used for:

Patients recovering from heart failure, or lung failure or heart surgery.
As a bridge option to further treatment, i.e. when doctors want to assess the state of other organs such as the kidneys or brain before performing heart or lung surgery.
Providing support during high-risk procedures in the cardiac catheterization lab after massive heart attack.
As a bridge to a heart assist device, such as left ventricular assist device (LVAD).
As a bridge for patients awaiting lung transplant. The ECMO treatment helps keep tissues well oxygenated, which makes the patient a better candidate for transplant.
Severe lung failure following Swine Flu infection (H1N1).
Severe lung failure following Dengue fever.

Acute Respiratory Distress Syndrome (ARDS) secondary to pneumonia, aspiration, severe air leak
Refractory Septic / Cardiogenic Shock
Myocarditis - Viral, scorpion sting
Post Arrest shock
Meconium Aspiration
Congenital Diaphragmatic Hernia
Persistent Pulmonary Hypertension
Poisoning

Studies have shown upto 70% success rate with Extra Corporeal Membrane Treatment (ECMO); however, in most of the cases the results depend on how serious is the lung injury at the time of starting this therapy.

Reviewed by Dr. Madhav Rao Shinde, Cardiac Sciences, Cardiac Surgery (CTVS) on 06-Sep-2022