Pediatric Extracorporeal Membrane Oxygenation (ECMO)

What is ECMO?

ECMO is treatment that pumps blood outside a child’s body through a machine that removes carbon dioxide and returns oxygen-rich-blood to the body. The machine circulates oxygen-rich blood throughout your child’s body when their heart and lungs don’t work well enough.

Like a heart-lung bypass machine used during open-heart surgery, ECMO takes over the function of the heart and lungs. A child can be on ECMO therapy much longer than a bypass machine, for a few days to weeks. During this time, your child stays in our intensive care unit (ICU) and receives care from our dedicated specialist team.

Sometimes, children need transportation that includes ECMO. ECMO transport helps get critically ill children to hospitals that offer the advanced care they need. Children’s Health is one of just five hospitals in Texas to offer this service.

What are the benefits of ECMO?

By doing the work of the heart and lungs, ECMO provides time for your child’s body to rest, heal and recover. Your child may need ECMO:

• While their heart and lungs fully develop (premature babies)
• Before and/or after heart surgery
• While waiting for a lung or heart transplant

Children may need ECMO for a variety of conditions, including:

• Congenital heart diseases (problems with the heart structure that were present at birth)
• Severe infections such as pneumonia and sepsis
• Breathing problems such as respiratory distress syndrome (a breathing disorder in newborns)
• Congenital diaphragmatic hernia (a hole in the diaphragm)
• Pulmonary hypertension (high blood pressure in lung arteries)
• Severe heart failure or respiratory failure

What are the risks of ECMO?

ECMO is safe, effective therapy that provides lifesaving breathing and heart support for critically ill children. At Children's Health℠, we use ECMO only for very sick children for whom other treatments have not helped. Like any treatment, ECMO has certain risks, including:

• Bleeding as a result of taking blood thinners
• Blood clots
• Infection
• Seizures
• Strokes

In our ICU, your child receives care from a critical care team with special training and experience in using ECMO with children. We do everything possible to help prevent these complications, providing 24/7 monitoring and close attention to their care.

What are Children’s Health’s outcome metrics for ECMO?

Children who undergo ECMO at Children’s Health have a 60% to 70% chance of surviving. These numbers have increased over the years as technology, research and training advance. And Children’s Health’s survival rates for ECMO are, on average, 10 to 15% higher than the national benchmark in most categories.

Our patient outcomes exceed international benchmarks set by the Extracorporeal Life Support Organization (ELSO). As a result, ELSO has recognized Children’s Health as a Gold Center of Excellence.

What to expect with ECMO

Treatment with ECMO differs for each child depending on the underlying condition or injury that’s causing heart and lung problems. Here’s what you and your family can generally expect with ECMO.

What to expect before ECMO

Your child’s care team decides to use ECMO when other treatments are not enough to support your child’s heart and lungs. Our dedicated ECMO team then stabilizes your child for surgery and prepares the equipment.

Your child receives general anesthesia and pain medication before the procedure. Surgeons use thin tubes called catheters to connect your child to the equipment. They insert the catheters into blood vessels in your child’s neck or groin.

What to expect during ECMO

The ECMO machine includes three main parts:

• The pump works as an artificial heart, receiving blood from the right side of your child’s heart through the catheters.
• The oxygenator serves as an artificial lung, adding oxygen to and removing carbon dioxide from the blood.
• A warmer heats the oxygen-rich blood before the machine returns it to your child’s body through the catheters.

Your child may be on ECMO therapy from a few days to several weeks, depending on the type of condition and other treatments they receive. Our ECMO team monitors your child 24/7 and adjusts the equipment as needed. While your child undergoes ECMO, you can visit anytime and sleep overnight in their room.

Children usually remain under anesthesia while on ECMO, but your child may be awake at times. Our Child Life Services team helps keep your child calm and entertained during ECMO. The specialists bring movies, emotional support animals and iPads to help relieve stress and provide a comfortable experience for your child.

As your child’s heart and lungs improve, the care team decreases ECMO support to allow their heart and lungs to take on more function. The team removes the catheters and other equipment when your child’s heart and lungs can function on their own.

What to expect after ECMO

Your child remains on a ventilator, after coming off the ECMO equipment, as their health improves. The recovery time for each child is different and may take weeks or months. Your child may need follow-up care and rehabilitation, but children who survive ECMO are able to go back to their regular activities. The care team can explain the details and show you how to care for your child during recovery.

What questions should I ask my provider about ECMO?

• How many ECMOs have you performed?
• How long will my child need to stay in the hospital after they finish ECMO?
• Will my child go home with any special equipment after undergoing ECMO?