Pediatric Extracorporeal Membrane Oxygenation (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.
- Extracorporeal - meaning outside the body
- Membrane - refers to the artificial lung
- Oxygenation - term for adding oxygen to the blood
At the beginning of the ECMO procedure, the team works to stabilize the baby and prepares the machine with fluid and blood. Surgeons attach the ECMO pump through catheters into large blood vessels in the infant’s neck or groin.
The ECMO machine consists of three parts working in concert to oxygenate a child's blood:
- The pump works as an artificial heart, taking "blue," non-oxygenated blood from the right side of an infant’s heart
- The oxygenator is the artificial lung, adding life-giving oxygen to the blood
- A warmer heats the oxygenated "red" blood before returning it to the patient
What are the common uses for ECMO?
It’s most commonly used in cases of respiratory failure, but other reasons it may be necessary include
- A bridge to transplant — to perform vital functions until a donor organ is available
- Congenital diaphragmatic hernia (CDH)
- Congenital heart malformations or conditions
- Heart surgery recovery
- Meconium aspiration syndrome (MAS)
- Persistent abnormally high blood pressure
- Respiratory distress syndrome
- Severe air leaks
- Severe pneumonia
- Severe pulmonary hypertension
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 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 Heart Center has an active extracorporeal membrane oxygenation (ECMO) program (5-40 cases per year) for children with cardiac and cardiopulmonary diseases.
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.
Questions parents should ask
- How much experience does this hospital have with cardiac ECMO?
- How many ECMO cases are completed each year?
- How many dedicated ECMO specialists are on staff?
- What are the hospital’s outcome statistics for patients treated with ECMO?
- Is ECMO available 24 hours a day for emergency resuscitations?
- Is ECMO available if my child's surgeon is unavailable?