Extracorporeal Membrane Oxygenation (ECMO)
Extracorporeal Membrane Oxygenation (ECMO): Understanding the Procedure
Extracorporeal Membrane Oxygenation (ECMO) is a modified cardiopulmonary bypass technique that provides temporary respiratory and/or cardiac support to patients with life-threatening conditions1. It is used for patients with reversible cardiopulmonary failure from pulmonary, cardiac, or other diseases4.
How ECMO Works
ECMO involves diverting blood outside the body to an artificial lung (membrane oxygenator) that adds oxygen and removes carbon dioxide; then, the blood is returned to the patient1. This process provides respiratory and/or cardiac support, allowing the patient’s lungs and heart to rest and recover1.
Types of ECMO
- Veno-Venous (VV) ECMO: This configuration provides artificial oxygenation and decarboxylation in patients suffering from hypoxemic and/or hypercapnic respiratory failure while preserving cardiac function1. VV-ECMO returns blood before it enters the pulmonary circulation3.
- Veno-Arterial (VA) ECMO: VA-ECMO bypasses the patient’s heart and lungs, diverting part or all of the blood flow through the ECMO circuit3. It is indicated for patients with refractory cardiogenic shock with an underlying potentially reversible heart condition but can also be used as a bridge to a ventricular assist device (VAD) or cardiac transplantation3.
- Veno-Pulmonary (VP) ECMO: In patients with acute cor pulmonale, VP-ECMO has been shown to improve right ventricular (RV) function, decrease vasoactive inotropic score, and improve oxygenation in patients with ARDS2.
Indications for ECMO
ECMO is considered when other standard therapies have failed3. Indications for VV-ECMO initiation include13:
- ARDS due to infectious or inflammatory causes
- Aspiration pneumonitis
- Blunt chest injury
- Refractory status asthmaticus
- Failed lung transplant graft
- Trauma (pulmonary contusion)
- Pulmonary embolism (if acceptable cardiac function)
- Pulmonary hypertension (after pulmonary endarterectomy)
VA-ECMO is indicated in patients with refractory cardiogenic shock with an underlying potentially reversible heart condition. It can also be used as a bridge to a ventricular assist device (VAD) or cardiac transplantation and as a salvage technique during cardiac arrest3.
Contraindications
Some contraindications of ECMO include progressive, non-reversible disease6.
Potential Complications
Maintaining close vigilance and management of complications during ECMO are critical to successful ECMO support1.
