What is ECMO?

Extracorporeal Membrane Oxygenation, or ECMO, is a form of advanced life support for patients with severe cardiac or respiratory failure. Blood is pumped out of the body, oxygenated, and then returned to the body. ECMO is an advanced capability and performed at specialized centers by a multidisciplinary team of physicians, nurses, perfusionists, and support staff with experience in managing and caring for these severely ill patients.

Causes

Indications for respiratory failure

ECMO can be considered for any patient with severe respiratory failure and a potentially reversible etiology (pneumonia, aspiration, volume overload) who meets the following criteria:

  • Hypoxemic respiratory failure with PaO2:FiO2 < 100
  • Respiratory acidosis with pH < 7.20 despite optimal ventilator management
  • Initiation of ARDS rescue therapies (PEEP > 15, prone positioning, inhaled nitric oxide, neuromuscular blockade)
  • Respiratory failure with significant barotrauma (bronchopleural fistula, pneumothorax, subcutaneous emphysema, etc.)

Indications for cardiac failure

ECMO can be considered for any patient with severe cardiac failure and a potentially reversible etiology who meets the following criteria:

  • Severe refractory cardiogenic shock on moderate dose of 2 or more inotropes/pressors and/or use of other mechanical device (balloon pump, Impella, etc)
  • One of the following: urine output less than 30mL/hour, CVP over 16, lactate over 4. mmol/L
Treatment

ECMO is the process of removing and oxygenating the patient’s blood and returning the blood to the patient’s body. Patients are closely monitored during this process to allow them to focus completely on healing. There are different types of procedures dependent upon the type of failure the patient is experiencing.

  • VV ECMO (Veno-Venous), supports lung function primarily, patients in severe respiratory failure
  • VA ECMO (Veno-Arterial) supports both heart and lung function, patients with cardiac failure and in cardiogenic shock

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