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What is ECMO?
ECMO, extracorporeal membrane oxygenation, temporarily acts as a patient's heart and lungs while he or she recovers from an underlying condition. It is comprised of an intricate circuit in which a portion of the patient's blood is removed through a tube and flowed through the ECMO machine, where it is enriched with oxygen and pumped back into the body.
ECMO is typically used with patients who are critically ill and who haven't responded to standard advanced life support (treatment with a ventilator or medications). ECMO may help with patient's breathing and circulation until a longer-term solution can be found.
Babies and children placed on ECMO have serious, but reversible, medical conditions that impair heart or lung function, or both. While a child awaits treatment or recovers from treatment, the ECMO machine does the work for the child's heart and lungs, until these vital organs recover and can function well independently. ECMO maintains blood flow and oxygenation to the vital organs (liver, kidney, brain), so that the function of these organs are maintained while the heart or the lungs recover.
ECMO has been successfully used in the following ways:
For babies and children with severe lung conditions. Lungs provide oxygen to the body through blood, and remove carbon dioxide from blood. Sometimes, when lungs aren't functioning because of illness or injury, the problem is so severe it cannot be helped with support from medication or respirators. ECMO may be used to support lung function in the case of severe lung conditions such as neonatal respiratory distress syndrome, congenital diaphragmatic hernia, neonatal meconium aspiration syndrome, pulmonary hypertension, severe pneumonia, or respiratory failure.
As a bridge to cardiac surgery for newborns. Some newborns have severe heart failure or elevated pressures in the pulmonary arteries of their lungs, and may not be able to maintain a normal blood pressure or oxygen level in the blood. On a number of occasions, ECMO has been used to support and rest the heart after birth, to allow newborns to recover before undergoing successful cardiac surgery.
For infants and children who undergo cardiac surgery. Sometimes, following heart surgery, the heart doesn't function well enough to support sufficient blood flow and oxygen delivery to the organs and tissues of the body. ECMO can be used in this circumstance to provide sufficient blood flow and oxygen to vital organs while the heart recovers. On some occasions, the heart does not recover following surgery and further investigation is needed. This may include moving a patient on the ECMO circuit to the cardiac catheterization laboratory to measure pressures in the heart and inject dye to look for problems.
As a bridge to heart transplantation. Heart failure in children can occur following surgery, or in children with other heart conditions such as cardiomyopathy and myocarditis. In these children, a heart transplant may be needed if the heart can't supply sufficient blood flow and oxygen to the body. Patients may develop severe heart failure while waiting for a donor heart to become available. ECMO offers a short-term solution.
For infants and children who go into sudden cardiac arrest. ECMO is sometimes used as a backup to revive patients whose hearts stop beating when other treatments, such as medications or a respirator, do not work.
Children’s expertise helps teen recover from crash
In February, after being unconscious for more than six weeks, 16-year-old Alan Moos woke up in a hospital bed at Children's – Minneapolis. "The first thing I remember saying was, 'What am I doing here?'" Alan recalled. Little did Alan know the more appropriate question might have been "How fortunate am I to be here?"
Extracorporeal Membrane Oxygenation
ECMO services are provided for both neonatal and pediatric patients with severe respiratory and/or cardiac insufficiency that is unresponsive to mechanical ventilation and medical therapy. Staff are available 24 hours a day for professional consultation, patient transport, or provision of ECMO. Available only at Children’s - Minneapolis.
The most common diagnoses leading to a need for ECMO are:
- congenital diaphragmatic hernia
- meconium aspiration
- veno-venous ECMO
- veno-arterial ECMO
- temporary ventricular assist devices
All criteria for transfer assume an effort to stabilize with appropriate use of mechanical ventilation and inotropic therapy. These are not criteria for ECMO (see separate document); they are an attempt to identify patients with a high likelihood of benefiting from ECMO, at a point where transfer is reasonably safe.
Criteria for neonatal ECMO
All criteria assume optimal support of respiratory and/or cardiovascular failure including mechanical ventilation, trial of nitric oxide, volume expansion, and appropriate inotropic support. We recommend not exceeding a PIP of 35 (30 for diaphragmatic hernia patients) on conventional ventilation, an HFOV AMPlitude of 40 (35 for CDH patients), or a MAP of 20 (15 for CDH patients), prior to qualifying for ECMO. A transient improvement should not cancel plans for ECMO.
These criteria and exclusions apply to patients 4 weeks to 25 years of age, with an acute reversible disease process and evidence of either cardiovascular failure and/or respiratory failure. Consultation with an ECMO consultant is recommended.
For Health Professionals
Neonatal Referral (NICU)
Pediatric Referral (PICU)
Families who have questions may call (612) 813-6433