ECMO is a specialized treatment procedure. It has the potential to manage critical illness in all patients, including children.
- What is ECMO?
Extracorporeal Membrane Oxygenation (ECMO) is a method of providing oxygen to the body. ECMO treatment is needed when the lungs or heart cannot supply oxygen optimally. It is a life support machine. Children who have a severe and life-threatening illness preventing their heart or lungs from working properly need ECMO support. For example, ECMO is used during life-threatening conditions like lung damage from infection, shock after a massive heart attack, etc.
There are two types of ECMO:
- VENO-VENOUS (V-V) ECMO – It is used when the heart is functioning, but the lungs need to rest and heal.
- VENO-ARTERIAL (V-A) ECMO – Here, the heart and the lungs need to rest and heal.
- Why is ECMO used?
ECMO is generally used for critical patients who have the following conditions:
- The lungs are unable to provide enough oxygen to the body even when given extra oxygen
- The lungs cannot get rid of carbon dioxide even with a mechanical ventilator
- The heart is unable to pump enough blood to the body
- ECMO may help support people with heart or lung disease that doctors cannot treat while they wait for an organ transplant.
- What is the difference between ECMO Therapy and Mechanical Ventilator (Breathing Machine)?
- Both the ECMO and mechanical ventilator help deliver oxygen to the body when the patient’s lungs fail. It is used when a patient does not respond to oxygen provided using a mechanical ventilator. When a patient’s lungs are severely affected, ECMO therapy is required to supply oxygen to the body.
- Where a mechanical ventilator helps the patient by pushing oxygen to the lungs with pressure, ECMO delivers oxygen directly through the catheter placed in the patient’s vein or artery.
- What should one expect when a child is on ECMO Treatment?
The ECMO is in a mechanical ventilator that delivers a controlled amount of pressure and oxygen to the lungs. Sedation is used for the child during ECMO. The child must be at rest during the ECMO treatment under the supervision of a specialist.
- What are the daily tests for someone at ECMO?
ECMO patients are monitored round the clock. They need constant monitoring of their vital signs, including blood pressure and oxygen levels. In addition, they need daily blood tests because average blood counts are essential to see if the ECMO treatment is working.
The child’s blood needs to be tested for administering various medicines including anticoagulant drugs (“blood thinners” such as heparin) during ECMO support. Every day a patient should have a neurological examination to see if there is enough oxygen in the brain. Bedside imaging tests are performed to monitor the patient’s progress. It includes X-rays to check the position of the cannula and monitor inflation of the lungs, ultrasound to monitor bleeding complications, an electroencephalogram (EEG) to monitor brain activity, and an echocardiogram (EEG) to evaluate how the heart is working.
- How long can one stay in ECMO?
The ECMO treatment duration varies depending on many factors. Because of the risks of ECMO discussed above, doctors try to wean patients off ECMO as early as possible. Often the patient stays on the ECMO for 1-2 weeks. Some blood and imaging tests are needed daily to determine if a patient is ready to be taken off ECMO support.
- ECMO Team Liability
ECMO treatment is administered and monitored by an experienced and qualified ECMO team as it is a complex life support system.
When your child is on ECMO, they will be cared for by a team of Paediatric Intensivists, Cardiologists, Cardiac Surgeons, Nurses, and Other Specialists.
A proficient nurse and an ECMO specialist should always be at your child’s bedside.
The team monitors vital signs and comfort, provides care, and maintains the ECMO. An “in-house ECMO specialist percussionist” should always be available as a resource to the staff.
A team of doctors will make several rounds every day to monitor your child’s progress and convey that report to you.
ECMO treatment has its share of adverse effects. Whenever large catheters are placed in any patient’s veins and arteries, there is always a risk of bleeding and infection. To avoid clot formation, all patients on ECMO are placed on a blood thinner called heparin. It decreases the risk of bleeding. As the vitals of your child improve, the team of ECMO specialists gradually wean them off the support.