ECMO
Extra Corporeal Membrane Oxygenation
CONTENT
What is ECMO
Who needs ECMO
How does ECMO work
Who will care for my baby
How long will my baby be on ECMO
What care will my baby have
What are the possible risks/complications
What can a Parent Do
WHAT IS ECMO
1. ECMO stands for Extra Corporeal Membrane Oxygenation.
a. Extra corporeal means “outside the body”
b. ECMO is a procedure that uses an artificial lung (membrane) in a machine outside the body (extra corporeal) that delivers oxygen to your baby’s blood and body tissues & organs (oxygenation)
c. ECMO is similar to the heart-lung bypass machine used for open heart surgery except it is used for a longer period of time.
2. ECMO does not cure the lung or heart disease but it is a temporary artificial lung and heart for your baby.
a. It takes over the work of the lungs and heart allowing time for them to rest and heal
b. When the lungs are not able to do their usual job, they cannot provide oxygen to the body nor can they remove carbon dioxide (a waste product), as they should
c. If the baby’s heart is not able to do its usual job, it may not be able to move blood throughout the body, as it should.
3. There are two (2) types of ECMO: Veno-arterial (VA) and Veno-venous (VV). Each type refers to the blood vessels that are used during the procedure.
a. VENO-ARTERIAL ECMO: In this procedure, a catheter takes blood from a vein (veno) and passes the blood through the ECMO machine—to remove waste products (carbon dioxide) and add oxygen—then returns it to the baby’s body under pressure into an artery (arterial)
b. VENO-VENOUS ECMO: In this procedure, a catheter takes blood from a vein (veno) and passes the blood through the ECMO machine—to remove waste products (carbon dioxide) and add oxygen—then returns it to the baby’s body under pressure into another major vein (venous). Sometimes babies start with VV ECMO and need to be changed over to VA ECMO.
4. If the Neonatologist and Pediatric Cardiologist believe your baby may be helped by ECMO they will talk with you about your baby and what they recommend.
a. Please feel free to ask questions.
5. ECMO is not done here at Cape Fear Valley Medical Center but if the decision is to transfer your baby to a hospital that does do ECMO we will make these arrangements.
a. You will be asked to sign a consent giving Cape Fear Valley Medical Center permission to transfer your baby.
WHO NEEDS ECMO
1. ECMO provides support to babies who:
a. Have lung or heart disease that the usual respiratory support with a ventilator, medicines, extra oxygen and other treatments have not worked. This might include:
● Persistent Pulmonary Hypertension (PPHN)
● Meconium Aspiration Syndrome
● Respiratory Distress Syndrome (RDS)
● Streptococcal Sepsis (infection)
● Asphyxia
b. Have congenital diaphragmatic hernia.
2. When your baby arrives at the hospital that will be doing the ECMO procedure:
a. The doctors there will talk with you more about ECMO
b. They will examine your baby
c. They will draw lab work and get a head and cardiac (heart) ultrasound—these all help the doctors decide if ECMO will help your baby and which type of ECMO—VA or VV—is best
d. A member of the ECMO Team will explain the tests and what they mean.
HOW DOES ECMO WORK
1. Once the decision is made to “put” your baby on ECMO, he/she is placed on a special elevated bed. This allows blood to drain by gravity into the ECMO machine.
2. The baby receives several medications before the procedure:
a. A local anesthetic at the site where the cannulas (tubes) are to be inserted (placed)
b. A medication for pain to keep him/her comfortable
c. A medication that temporarily restricts his/her movement.
3. The surgeon inserts (places) the cannulas into the large blood vessels (artery/vein) of the baby’s neck.
4. At the same time, the rest of the ECMO Team fills the ECMO circuits (tubing) with blood.
5. The physician connects the cannulas to the ECMO circuit—your baby is now on ECMO.
THE PROCEDURE
● Dark red blood containing very little oxygen slowly drains into the circuit of the ECMO machine.● The ECMO machine is a pump (the artificial heart part of the machine) that pumps the baby’s blood through the rest of the ECMO machine.
● The blood is 1st pumped into the oxygenator (the artificial lung part of the machine) where carbon dioxide (a waste product) is removed and oxygen is picked up.
● The blood is next pumped into the heat exchanger where it is warmed to body temperature.
● Finally, this bright red blood containing sufficient oxygen for your baby is pumped back into your baby.
● This procedure is continuous as long as your baby is on ECMO.
6. Your baby still remains on the ventilator during ECMO but the settings will be lower than before giving the lungs time to rest and heal.
WHO WILL CARE FOR MY BABY
1. Your baby needs highly specialized care provided by a Team with additional skills and training.
2. The ECMO Team caring for your baby usually includes:
a. ECMO Physician: The primary physician in charge of your baby
b. Pediatric Surgeon: The surgeon inserts the ECMO cannula
c. Resident Physician: A medical doctor who is in training; they will carry out much of the baby’s care under the supervision of the ECMO physician
d. ECMO Specialists: These are Registered Respiratory Therapists with additional ECMO training who do the minute-to-minute monitoring and management of the ECMO equipment and are at your baby’s bedside at all times
e. Critical Care Nurses: These are registered nurses with additional ECMO training who will manage and provide the hands-on care for your baby. In addition, they may be a good source of information for you. They also are at your baby’s bedside at all times
f. Respiratory Therapists: These professionals are specialists in ventilator and oxygen management, make suggestions/recommendation to other team members and assist with procedures
g. ECMO Coordinator/Social Worker/Chaplain: These individuals—it may be one or all of them—will help you with the everyday events that go with having a baby on ECMO and perhaps being a distance from your family and friends. They can help with things like: finding a place to stay, dealing with insurance or financial concerns, parking and/or meals. They provide spiritual and emotional support during this trying and tiring time.
HOW LONG WILL MY BABY BE ON ECMO
1. The average length of ECMO treatment is about 10 days—some babies will need less time on ECMO while other babies will need more time on ECMO.
2. The length of time your baby is on ECMO depends on the type and/or severity of your baby’s lung and heart disease.
3. Initially, the ECMO machine settings will be high so the machine does most of the work of the lungs and heart and provides maximum support for your baby.
4. As your baby gets better, the ECMO settings will be lowered and your baby’s lungs and heart will be allowed to slowly do more of its usual work.
5. As the ECMO Team sees that your baby’s lungs and heart are continuing to improve your baby will be “tried off” ECMO (cannulas clamped but not removed) for a few hours.
6. If your baby continues to do well and is stable during this time, ECMO support is no longer required and the cannulas will be removed.
7. At the same time as your baby is removed from ECMO, his/her respiratory support (ventilator) settings will again be increased. These settings will be decreased as your baby continues to improve.
WHAT CARE WILL MY BABY HAVE
1. During ECMO the physicians will see your baby daily and the baby’s condition carefully assessed and monitored.
2. Various tests will be performed as needed:
a. Daily chest x-ray
b. Head ultrasound
c. EEG (a tracing of the baby’s brain activity)
d. Cardiac ECHO to assess heart function and recovery.
3. Blood samples for lab work—these samples are taken off the ECMO circuit or IVs, the baby is not “stuck or poked” to get these samples.
4. Medications:
a. Your baby will be allowed to be as alert as possible but kept comfortable. Therefore, your baby may receive pain medication on a regular basis to prevent discomfort
b. Some babies receive medication to help them sleep and to keep them from moving around too much and dislodging the cannulas
c. Heparin keeps the blood from clotting and is added when the ECMO cannulas are placed and added continuously throughout the procedure to keep blood clots from forming in the ECMO tubing
d. Antibiotics are given to treat any existing infections or to prevent infections
e. Dopamine, Dobutamine, Epinephrine are sometimes given if your baby’s blood pressure or heart needs help.
5. Blood Transfusions are given:
a. To maximize oxygen delivery to your baby’s organs and tissues, he/she may receive a transfusion of packed red blood cells
b. To minimize bleeding, your baby may receive a transfusion of platelets.
6. Fluids/Feedings
a. IVs will be in place to give the baby fluids and a special type of nutrition called TPN
b. While on ECMO your baby will not be able to nurse or take a bottle. Instead, an Oro- or Naso-gastric tube is inserted through the mouth (oro) or nose (naso) that goes to the stomach to give the baby feedings
c. Both breastfeeding and bottle-feeding will be started once your baby is off ECMO. If you plan on breastfeeding continue to pump your milk and freeze it for use later.
7. Other care:
a. Daily weight & Bath
b. Constant monitoring of the baby’s vital signs
c. Frequent Position changes
d. Suctioning of the endotracheal tube (ET Tube) to remove secretions, as needed
e. Recording the baby’s urine output.
WHAT ARE THE POSSIBLE RISKS/COMPLICATIONS
1. A baby that needs ECMO is very ill and may become worse without ECMO.
2. However, there are possible risks/complications associated with ECMO, this does not mean that every baby will have every risk/complication.
3. Some of the risks/complications include:
a. Bleeding—this is the most common complication and can happen in various parts of the body
b. Intraventricular Hemorrhage (IVH)
c. Seizures
d. Infection
e. Cardiac arrhythmia (irregular heart beats)
f. Hypertension
g. Pneumothorax (an “air” leak in the lungs)
h. Hyperbilirubinemia (jaundice)
i. Changes in the levels of the baby’s sugar, calcium, sodium and/or potassium
j. Renal failure.
4. The ECMO physician and Team will talk with you about these possible risks/complications.
WHAT CAN A PARENT DO
1. An important part of the baby getting better is the parents’ love and concern. Visitation is usually strongly encouraged.
2. There are many things you can do to help with your baby’s care—clean their eyes, clean their mouth and keep it moist, change their diaper, help with their bath—just to name a few.
3. Although you will not be able to pick up and hold your baby, you are encouraged to talk or sing quietly to them, gently touch them if tolerated by the baby, or provide a special toy. Talk with your baby’s nurse about this.
4. Your love and attention will go a long way in helping your little one on the road to recovery.
5. Keep up with your baby’s progress each time you visit or call.
6. It’s also important that you take care of yourself, make sure that you eat well and get some rest. Do not feel that you must be at your baby’s bedside every minute.
Reviewed/Revised: 02/07…..06/13
ECMO 7