Extracorporeal Membrane Oxygenation (ECMO)
In the fetal neonatology program at Children’s Health℠, a highly complex treatment is performed by specially trained staff to help improve outcomes for critically ill newborns and infants.
Why Children's Health℠?
Babies being treated with ECMO require the most specialized care because the treatment is both complex and associated with significant risks, including mechanical problems that might cause the pump to stop working. That’s why it’s crucial that the team members have the greatest expertise. At Children’s, the ECMO team members are specially trained coordinators, surgeons, nurses, and respiratory therapists.
Children’s Health has been using lifesaving ECMO for more than 25 years. Since that time more than 550 patients have been treated with ECMO, an average of 30 to 40 patients a year in recent years. Having nearly doubled its extracorporeal membrane oxygenation services in the past several years, Children’s staff is exceedingly proficient at employing this technique to help the region’s tiniest children, and is able to mobilize within 20 to 30 minutes to place a baby on ECMO.
Children’s Health has been designated a Center of Excellence by the Extracorporeal Life Support Organization (ECLS) —recognition that that the program meets the highest quality standards, has specialized equipment and supplies and defined patient protocols, and provides advanced education to all staff members. This award of excellence is among the criteria U.S. News & World Report and Parent’s magazine use when ranking Children’s Health among the nation’s top pediatric hospitals.
US News & World Report also ranks Children’s Health among the nation's top programs in Neonatology. This ranking highlights our dedication to exceptional care and best practices as well as the use and availability of advanced treatments such as ECMO and its highly trained ECMO staff. If ECMO becomes necessary, you can be certain that your child will receive outstanding care from an expert team to ensure the best possible outcome.
What is ECMO
Extracorporeal membrane oxygenation (ECMO) is a complex, multidisciplinary therapy method usually reserved for very sick children for whom other methods have not been successful. It’s a type of life support system that may be used to help your baby’s lungs or heart function for a period of days or weeks while your baby heals.
If your infant needs ECMO, a machine will take over for the lungs, or, sometimes, for the heart and lungs, in much the same way as bypass equipment keeps a heart functioning during open heart surgery. Extracorporeal means outside the body, while the word membrane refers to the artificial lung. Oxygenation is the term for adding oxygen to the blood.
How does it work?
A pump (an artificial heart) and an artificial lung work together to oxygenate the blood without taxing the lungs. A surgeon will attach catheters, or tubes, to your baby through the large blood vessels in the groin or, more commonly, the neck. The machine will take blood that is not oxygenated from the right side of the heart and pump it through the artificial lung, which oxygenates it and removes carbon dioxide. The blood will be warmed before it is returned to your baby. At the same time, your baby will be on ventilator support.
At the beginning, the machine will do most of the work for the baby’s heart and lungs, letting them rest and recover their ability to function independently. Increasing blood levels of oxygen signal that the lungs are healing, and over time the ECMO machine will do less and less of the work of your baby’s organs.
It’s a delicate procedure with considerable risks, and the care that is required is complex. Therefore, after the surgery that connects the tubes, a team of ECMO specialists and nurses trained in ECMO will take over, staying at your baby’s bedside 24 hours a day to monitor and maintain the pump that runs the machine and make adjustments as needed. The ECMO-trained direct care nurses will spend their entire shift one- on- one with your baby.
After ECMO, your baby will need to stay on a ventilator for a little while in order to get enough oxygen and will be weaned over time. Recovery is gradual and may take weeks or months.
Why your baby would need ECMO
If your infant has heart or breathing problems, ECMO will help deliver oxygen while letting the heart and lungs rest so they can heal or while doctors are treating the underlying problem. It’s most commonly used in cases of respiratory failure, but other reasons it may be necessary include
- Congenital heart malformations or conditions (those present at birth)
- Respiratory distress syndrome
- Congenital diaphragmatic hernia — when the stomach or the intestines (or both) enter the chest cavity through an opening in the diaphragm
- Severe pneumonia
- Abnormally high blood pressure that is persistent
- Meconium aspiration syndrome — the result of a newborn inhaling its first stool before or during birth
- To help a baby recover after heart surgery
- As a bridge to transplant — to perform vital functions until a donor organ is available