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With the development in every aspect of life, medical inventions are the ones which impact thousands of lives positively. One such invention is ECMO treatment, read on to find more!
ECMO is an abbreviation for the treatment method known as extracorporeal membrane oxygenation. It is also known as extracorporeal life support. 1
An ECMO treatment is given to an individual whose heart or lungs cannot function adequately to meet the body’s demands. This treatment is given to those who need external cardiac or respiratory support.
Meaning and Functions of ECMO
An ECMO machine is used in the treatment, which pumps oxygen into the patient’s blood from outside the body. It collects blood into a tube, then travels to an artificial lung that is present in the ECMO machine.
This blood is then processed when oxygen and carbon dioxide are taken and disposed of in the blood.
The machine’s processed blood is now warmed up to average body temperature and is sent back to the patient’s body via tubes. Both lungs and heart get sufficient rest during ECMO treatment.
Initial Usage of ECMO
ECMO was first used in infants who were born with specific lung or heart diseases. Many infants were born with respiratory conditions such as respiratory distress syndrome or other congenital cardiac issues.
It was developed in the 20th century, in the 1960s, to be more specific. Lately, during the past few years, the ECMO machine has been adapted and adjusted for an adult, which can help in many health treatments.
ECMO comes in handy during many surgeries and transplantations. These will be discussed in the article below.
Types of ECMO Therapy
There are two types of ECMO therapy:
1. VA ECMO Therapy
When there are problems with a patient’s lungs and heart, a VA (Vein and Artery) ECMO treatment is carried out, where the ECMO machine is attached to the veins and the arteries.
2. VV ECMO Therapy
When only the lung is affected, a vein ECMO therapy will be carried out, where the ECMO machine is connected to the veins. The veins used are usually near the heart region.
The Procedure of an ECMO Treatment
At first, the doctors or medical team decide if there is a need for ECMO or not. It is usually carried out in individuals who are critical or are in life-threatening situations 2due to heart or lung-related disorders. If they see that there is a need, then the following steps will be carried out.
ECMO is set up by inserting plastic tubes into veins or arteries, or both depending on the health demands. The doctor will first prescribe certain medications before the start of ECMO treatment3 to keep the pain under control.
If needed, they may give additional medications to keep the patient relaxed during the process.
The tubes are taken through the patient’s neck, which is connected to the ECMO circuit or the ECMO machine. This tube collects the blood from the patient and sends it into an oxygenator or what we commonly call the artificial lung in the ECMO machine.
This artificial lung, as mentioned above, adds oxygen and gets rid of the carbon dioxide from the blood.
Once it completes this process, it sends the blood back to the body. The blood is carried into the patient’s body through a separate tube. It gives back the same pressure and temperature as the body’s heart or lungs would do. Hence it simply replaces an entire system.
When is ECMO Treatment Used?
ECMO treatment is used in certain health conditions where the lungs cannot process or provide oxygen to the body. It is also used in conditions where the lung is unable to get rid of carbon dioxide from the body, or it is also used when there is a lung failure.
Here are some lung or pulmonary conditions where ECMO is used:
1. Respiratory Failure
A condition where the lungs cannot produce enough oxygen makes breathing a challenging task.
2. Pneumonia
A kind of lung inflammation, where types of it depend on which lung and how the lung was inflamed. Double pneumonia and bacterial pneumonia are some examples of the same.
3. Pulmonary Embolism
A condition where there is a blockage in the arteries. The blockage could be caused due to a blood clot and requires medical assistance to heal.
4. Coronavirus
A viral infection that affects the respiratory system of the body. It further causes body pain, cold, and cough. Other symptoms are loss of taste and fever. ECMO treatment was administered to individuals during the pandemic to support their breathing.
5. Lung Failure
An ultimate inability of the lungs to carry out its essential functions. The lung can no longer process and generate oxygen needed for the body.
6. Lung Transplant
A surgical procedure where a failed or diseased lung is removed and replaced by another healthier lung received from a donor.
7. Congenital Diaphragmatic Hernia
A condition where there is a hole in the diaphragm of the body which is formed during fetal development. This is congenital, meaning it is a condition that is present at birth.
8. Acute Respiratory Distress Syndrome
A condition where the air sacs are filled with fluids in the lungs. This hinders the lungs from carrying out their essential functions. This is often fatal and needs immediate medical attention.
9. Pulmonary Hypertension
It is a high blood pressure condition that affects the pulmonary of the lungs. This can make breathing very painful and challenging. This, too, needs immediate medical care.
10. Respiratory Distress Syndrome in Children
It usually occurs in premature babies. The earlier they are born, the more the probability of respiratory distress syndrome in the child. The child will need extra oxygen to breathe, and this too needs immediate treatment and attention.
An ECMO treatment is also given to patients when there are some unfavourable heart conditions, such as:
- Myocardial Infarction (Heart attack)
- Heart transplant
- Cardiogenic shock
- Any heart muscle disorders
- Heart muscle inflammation
- Low body temperature
- Severe heart damage
- Heart failure
- High-risk cardiac surgery
ECMO Support During Transplantation
As observed above, the ECMO machine is used during complicated lung and heart transplants.
The patient is attached to an ECMO machine during heart or lung failure while waiting for organs. This helps the body remain oxygenated as the patient awaits an organ.
An ECMO can also be given after surgery. This way, excess pressure is not bestowed upon the healing organs. At the same time, the body is not deprived of oxygen supply.
This will keep the patient alive as long as he gets the organ. ECMO helps in many severe conditions, especially when the patient has to be rushed into an intensive care unit.
How Long is ECMO Therapy?
The duration of ECMO treatments depends on the health issue. The health care team will decide the duration by checking the patient’s condition regularly.
However, on average, a person can stay on ECMO treatment anywhere from 1 week to 20 days.
How Do Patients on ECMO Breathe?
Patients are intubated during ECMO. These individuals are connected to a breathing tube, an endotracheal, or an ET tube. This is placed on their nose or mouth and is connected to the windpipe.
Endotracheal intubation is done to keep the air pathways open so that medicines or anesthesia can be given. In our case, it could also be oxygen.
As mentioned above, ET is used as a breathing support system during respiratory failure or other respiratory complications, such as pneumonia, lung infections, or other heart-related diseases.4 Ventitlotrs and ETs are traditional methods, whereas an ECMO is an advanced treatment option.
What are the Advantages of ECMO Therapy?
1. Better than Ventilators
Ventilators directly add oxygen to the body when there is an oxygen deficiency. Pushing oxygen into the patient’s lungs can increase the oxygen levels and the pressure in the body.
It is important to note that the lungs in the condition are already weak. Hence excess pressure on the lungs can further damage the lungs.
High oxygen pressure is known to damage the lung. Hence lung failure could be caused due to the use of ventilators. Due to the same reason, ventilators cannot be used for long periods, as they can potentially cause respiratory failure.
On the other hand, ECMO allows rest to the lungs. It processes the blood of the body externally and gives it back to the body. In other words, it temporarily replaces the lungs by doing its function.
While ECMO might not help the lung disease in itself, it will at least give it some rest and continue to produce the necessities for the body.
2. Provides Oxygen to the Body
ECMO perfectly delivers the role of processing the patient’s blood. This can, therefore, be used in severe heart or lung conditions. It is usually used during the times of surgery, such as open-heart surgeries, where the heart temporarily cannot do its function.
Side Effects or Risks of ECMO Treatment
Anything that is not natural comes with its complications. Similarly, ECMO treatment also has its side effects.
1. Blood Clots
Blood clots may be formed in the ECMO machine that might enter the patient’s system. This blood clot has the potential to cause severe complications.
During such difficulties, the ECMO circuits must be changed with the help of the medical team; the medical team must be conscious while administering an ECMO treatment. It is necessary to check the therapy during intervals, as there is a risk of thromboembolism and coagulopathy.5
2. Bleeding
This is one of the most common side effects that occur during an ECMO treatment. This occurs in around 30% of the patients who are receiving ECMO.
Bleeding occurs as a result of continuous anticoagulation that takes place during the ECMO treatment. It can also occur due to platelet dysfunction, immediate medical intervention must be made in such situations.
3. Cannulation-Related Side Effects
Cannulation refers to inserting a tube into the patient’s body. A cannula is a thin tube inserted into the body to collect blood and send it back into the body.
Firstly, during cannulation for ECMO, one can face arterial dissection, where there is damage caused to the artery the cannula was inserted into. A tear in the artery or the lining of the artery could pose health risks for the patient.
Secondly, a person may also face vessel perforation. This can also come with hemorrhage that needs immediate attention.
Thirdly, distal ischemia, where a person completely loses the functionality of the hand. Immediate care must be given in such situations.
It is important to note that these complications are rare and occur in very few patients. Nevertheless, cannulation must be carried out by medical experts. ECMO therapy in itself must be done in the presence of an expert medical team, who are prepped and can handle any complications.
EndNote
ECMO treatment is an advanced technological aid in respiratory and cardiac treatments. ECMO treatment has helped several patients recover after surgeries, it reduces the pressure on your organs, giving them enough time and rest to heal.
One can go for an ECMO treatment without any worries. The doctors need to monitor the process regularly to check for any circuit defects or complications.
ECMO treatment needs to be carried out under expert supervision only. The doctor further decides whether or not ECMO therapy needs to be carried out in the upcoming days for the patient.
Depending upon the improvement the patient has shown during the treatment, the doctors will gradually decrease their dependency on ECMO for their respiratory needs.
Hence, the duration of ECMO and its usage varies from patient to patient and in context to their health conditions.
Frequently Asked Questions
1. What are the risks of ECMO?
Bleeding, caused by a medication administered to stop blood clotting in the tubing, is one peril associated with ECMO.
Next, infections at the external entry points for the tubes and transfusion issues, because blood is supplied to people receiving ECMO, should be looked out for.
2. What is the quality of life after ECMO?
Long-term health/medical-related quality of life deficiencies for ECMO patients exist, necessitating ongoing patient monitoring.
3. How long can a patient survive on ECMO?
People can utilize ECMO for days or even weeks at a time. The reason a patient needs ECMO determines how long they will be on it.
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- Kim, Jun Hyun, et al. “Venovenous ECMO treatment, outcomes, and complications in adults according to large case series: A systematic review.” The International Journal of Artificial Organs 44.7 (2021): 481-488. ↩︎
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- Dobesh, Paul P., and Toby C. Trujillo. “Coagulopathy, venous thromboembolism, and anticoagulation in patients with COVID‐19.” Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 40.11 (2020): 1130-1151. ↩︎
Last Updated on by Sathi Chakraborty, MSc Biology
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