Choose the content to read
- Why ECMO?
- What conditions is ECMO used to treat?
- What is an ECMO procedure?
- When to stop using ECMO?
- What are the benefits of ECMO?
- ECMO at MedPark Hospital
ECMO
ECMO (extracorporeal membrane oxygenation) is an artificial heart-lung machine that provides life support to patients with severe heart and/or lung failure. ECMO purifies blood, infuses oxygen, removes carbon dioxide, and returns blood to the body. ECMO saves the lives of patients who have severe heart or lung failure due to coronary artery disease, myocarditis, acute myocardial infarction, or COVID-19 whose bodies do not respond to medications, ventilators, or standard life support. ECMO supports the functioning of the heart and lungs when the body is unable to exchange oxygen and carbon dioxide properly, helps save patients' lives while the doctors are rendering interventions, and aids in increasing survival rates.
Why ECMO?
In some patients with sudden cardiac arrest who have irregular heart rhythm, the heart does not contract normally, or sudden cardiac arrest without warning, resulting in the heart and internal organs not receiving blood, shocks, and unconsciousness. Basic first aid, such as CPR, intubation, or administering vasopressors and inotropes may not respond to treatment. ECMO takes over the heart and lung functions to keep blood pressure stable, increasing the heart's contraction rate and allowing critical patients to survive.
In critically ill COVID-19 patients with severe pneumonia, acute respiratory distress syndrome (ARDS), severe low blood oxygen levels (oxygen levels below 94), shock, coma, fever higher than 39 degrees, and unconsciousness from severe oxygen deficiency due to lung tissue destruction. ECMO takes over lung functions, maintaining blood oxygen levels and pumping blood distributed to organs including the brain and heart while doctors render treatments until patients survive and can recover from COVID-19.
What conditions is ECMO used to treat?
- Heart failure, such as sudden cardiac arrest, heart attack, coronary artery disease, myocarditis, acute myocardial infarction, cardiogenic shock from heart disease, or severe heart failure, does not respond to other treatments.
- Respiratory failure: Lungs are unable to maintain oxygen levels and remove carbon dioxide, such as severe pneumonia, severe acute respiratory distress syndrome, pulmonary embolism, or septicemia (bloodstream infection) affecting the lungs.
- After major surgery: Those who need to recover from major surgery, those with severe physical weakness, and those at risk of heart and lung failure following surgery, such as heart surgery, coronary artery bypass grafting, heart transplantation, or lung transplantation.
- Severe respiratory infections, such as influenza A, MERS, or COVID-19, cause severe lung tissue damage, resulting in pneumonia, bronchitis, respiratory failure, and possible death.
What are the indications for using ECMO?
The doctor will consider using Extracorporeal Membrane Oxygenation (ECMO) life support to maintain the function of the heart and lungs in critically ill patients with cardiopulmonary failure, based on the following indications for ECMO use:
- Veno-arterial ECMO (VA) is used in patients with severe heart failure or both lung and heart failure by inserting 2 oxygen cannulas into the groin, one in the major vein on one side and the other in the opposite groin. The doctor will consider inserting oxygen cannulas in the groin for adults and older children and the neck for young children to pump blood, infuse oxygen, remove carbon dioxide, and return blood to the body via the major arteries.
- Veno-venous ECMO (VV) is primarily used in patients with severe respiratory failure. VV involves inserting two oxygen cannulas connected to an ECMO machine through a single major vein side by side or two oxygen cannulas inserted through two major veins at different locations to pump blood, infuse oxygen, remove carbon dioxide, and return blood into the body via major veins.
What is an ECMO procedure?
- The anesthesiologist administers intravenous sedation, pain medication, and anticoagulants to numb the sensation and prevent blood clots.
- The surgeon inserts an oxygen cannula connected to the ECMO machine in 2 locations along the major veins in the groin and/or neck and arm, up to the heart.
- The ECMO machine functions as the heart and lungs in gas exchange by pumping blood through the oxygen cannula to the ECMO machine for purification. The ECMO machine purifies the blood by infusing oxygen and removing carbon dioxide before returning the blood to the body via the oxygen cannula.
- The purified blood will circulate back into the body, providing sufficient oxygen to nourish internal organs and allowing the patient to survive despite physical weakness and unconsciousness.
- While the ECMO machine takes over the heart and lungs, doctors will provide comprehensive interventions until the symptoms gradually improve, the patient is no longer in critical condition, is safe, and can breathe on their own until both the heart and lungs can function normally in exchanging gas sufficiently. The doctor will then consider gradually reducing and eventually discontinuing the use of the ECMO machine.
- After discontinuing the use of the ECMO machine, the doctor will continue to use the ventilator until the patient can breathe on their own before removing the ventilator. The patient may need to stay in the hospital for a while until their vital signs stabilize. The doctor will let the patient engage in physical therapy to regain muscle strength and speech therapy to help them rehabilitate their respiratory system.
How long does ECMO take?
The duration of the use of ECMO varies depending on the patient’s clinical conditions, treatment, and recovery period. Some patients may only need ECMO for 2-3 hours, while others may require it for several days or weeks, depending on the doctor’s discretion.
When to stop using ECMO?
The doctor will consider discontinuing the use of ECMO only when the doctor considers that discontinuing the use of ECMO is safe, the patient can breathe on their own without the need for a ventilator, both the heart and lungs can exchange gas adequately, and the body can recover progressively. When the patient can survive without relying on the ECMO, the doctor will gradually reduce its use until it can safely be discontinued.
What are the risks of using ECMO?
Typically, doctors will use ECMO in critically ill patients who already have severe physical weaknesses due to severe heart and lung failure, which poses a high risk of death. The potential risks associated with the use of ECMO are as follows:
- Bleeding is caused by anticoagulants taken before and during the ECMO procedure.
- Infections: Bacterial infection develops at the puncture site during ECMO life support, the doctor will immediately administer antibiotics.
- Kidney failure: In some cases, insufficient blood flow to the kidneys leads to kidney failure. However, symptoms will gradually improve following dialysis and the discontinuation of ECMO.
- Stroke: In very rare cases, a small blood clot can form in a brain blood vessel. The doctor will treat it right away.
- Pulmonary embolism: In a small case, a blood clot may form in the lungs. The doctor will treat it as soon as possible.
What are the benefits of ECMO?
- Support life while doctors treat heart and lung failure, allowing the heart and lungs to fully recover.
- Take control of the weakened heart and lungs following high-risk surgery, such as coronary artery bypass grafting or lung surgery.
- Save lives while waiting for organ transplants, such as heart or lungs, increasing the chance of survival and lowering the mortality rate.
- Aid infants with congenital heart disease and pulmonary complications, as well as premature infants whose hearts and lungs are not fully developed.
- Support life while transporting critically ill or emergency patients, lowering the risk of death during transport.
- Prolonging life during a coma allows doctors to fully intervene and gives family members time to consider end-of-life options.
What are the contraindications for ECMO?
- End-stage cancer patients
- Patients dependent on ventilators for an extended period
- Patients with aortic dissection
- Uncontrolled bleeding
- Patients with severe intraventricular bleeding and irrecoverable brain damage.
What is the survival rate of ECMO?
According to statistics, critically ill patients who receive ECMO to support their hearts and lungs have an overall survival rate of 33–62.9%. The adult survival rate is 57-66%; the children's survival rate is 57-67%; and the infant survival rate is 74-84%. In addition, when comparing the group that uses ECMO to the group that does not, it is found that the group that uses ECMO to support their lives has a survival rate as high as 90%.
ECMO at MedPark Hospital
Critical Care Center at MedPark Hospital in Bangkok, Thailand, is led by a team of experienced critical-care and emergency medicine physicians and nurse specialists who are ready to provide care for critically ill patients, emergency patients, or premature infants requiring 24-hours intensive care, using advanced medical technology and cutting-edge equipment, including ECMO life support, high-frequency ventilators, vital sign monitors, hybrid OR rooms capable of simultaneous diagnose and intervention, negative-pressure rooms for infection control, and ICU/CCU wards staffed with 1:1 or 1:2 nurses on duty 24 hours for close monitoring to provide immediate assistance in case of emergency, ensuring patients receive full medical care, aiding them to quickly exit critical conditions and returning to their normal state of life.
