ECLS means: Extracorporeal Life Support
ECMO means: Extracorporeal Membrane Oxygenation
You may hear us use both words to mean the same thing.
ECMO is used to help the heart and/or lungs when a person is critically ill. Blood is removed from the body through a machine where carbon dioxide is removed and oxygen is placed in the blood (similar to what happens in the lungs). ECMO does not fix the underlying heart or lung problem. It is used to support the body functions while the heart or lungs are trying to heal or recover.
This treatment may be needed when:
- A person has lung failure caused by trauma, pneumonia or other infection
- A person has heart failure that can occur after a heart attack or heart surgery
- Or before a person gets a cardiac device implant, heart transplant, or lung transplant
VV ECMO: In Veno-Venous (VV) ECMO blood is removed through a tube in a vein, sent through the machine, and returned into another vein. It is used for a patient with severely injured or sick lungs.
VA ECMO: In Veno-Arterial (VA) ECMO blood is removed through a tube in a vein, sent through the machine, and returned into an artery. VA ECMO can support a sick heart and sick lungs.
How is a person placed on ECMO?
To start ECMO, large tubes are inserted in the neck or groin (cannulation). There may be one or two tubes depending on the person's treatment needs.
- Blood is pulled out of the body by the ECMO pump and sent through an artificial lung which adds oxygen to the blood and removes carbon dioxide.
- The blood will be warmed to maintain the person's normal body temperature.
- The blood returns to the body through one of the ECMO tubes.
After your loved one is placed on ECMO, there will be many doctors and nurses involved in their care. This will include the Intensive Care team, the ECLS team, the palliative care team, and other specialist like cardiologists (heart), surgeons, nephrologists (kidney), neurologists (brain), and infectious disease (infection) doctors. The nurses caring for your loved one are specially trained to provide all of their care and run the ECMO machine.
There are people available in the hospital to support you and your family's needs as well. Ask to speak with a social worker if you need help with issues like meal tickets, transportation, or finding a place to stay. Chaplains are also available to you. We know this time can be very stressful for families. Please ask us any questions you have and share your concerns with us at any time.
Risks of ECLS
Bleeding is a common complication of ECMO, and some bleeding is normal. Blood products or surgery may be needed if there is too much bleeding. Blood thinners (like heparin) are required for most patients while on the ECMO machine to prevent clots. The levels of these medicines will be monitored closely.
Infections are a risk for any critically ill patient. We are always monitoring for any signs of an infection. Antibiotics may be given to treat or prevent infections during ECMO.
Blood Clots/Strokes: There is a small chance that a blood clot or air bubble can get into the blood of a patient on ECMO. There is also a small risk that bleeding may occur in the brain while on blood thinners. These can cause strokes.
Problems with the ECMO machine: members of the ECMO team, including your loved one's nurses are trained to take all the safety measures needed and handle rare emergency issues if they occur.
ECMO may be stopped if there are very severe complications from the treatment itself like uncontrolled bleeding, or life-threatening infections.
When to stop using ECMO
When your loved one is well enough, the health care team will talk with you about coming down on the ECMO support (weaning). When your loved one is ready plans will be made to stop ECMO and remove the tubes (decannulation). The person often stays on the breathing machine (ventilator), and different medicines to support heart and lungs. The ventilator will be removed when the patient is able to breathe well on his or her own.
ECMO can work well, but sometimes a persons' heart or lungs can't recover while on ECMO. After a trial on ECMO support the doctors will talk openly with you about your loved one's chance for recovery, and if the treatment is only prolonging the natural dying process.
Please talk with your health care team any time you have any questions or concerns.