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Welcome to Pediatric ECMO

ECMO
 

What is ECMO?

Extracorporeal Life Support Organization (ELSO) was formed in 1989 at that time there were 18 institutions that provided this specialized service. In 2011 there were 211 ECMO centers. The UTMB ECMO program was started in 1987 by Dr. Joseph Zwischenberger. Since that time we have cared for 260 patients (neonatal, pediatric and adults) with 65% survival.

ECMO are the initials which stand for extracorporeal membrane oxygenation. ECMO uses a heart-lung machine similar to the machine used in open-heart surgery. There are two types of ECMO. Venoarterial (VA) ECMO uses an artery and a vein. Venovenous (VV) ECMO uses one or two veins. The doctor will decide which one your child needs. Special plastic tubes (cannulas) are inserted into the large blood vessels in the neck and/or groin by the surgeon.

The ECMO machine does the work for your child’s lungs (VV ECMO) and heart (VA ECMO), which allows them time to rest and heal. During the time your child is on ECMO, he/she will still be connected to the breathing machine, also known as the ventilator. The ventilator is used to prevent the lungs from collapsing. At the beginning of ECMO, the ECMO machine does most of the work for their lungs (VV ECMO) and heart (VA ECMO). Even though your child will seem to be much better, it is important to remember that the ECMO machine is doing the work the lungs and/or heart cannot do.

To see how they are doing, a small amount of blood will be drawn from your child’s special IV, called an arterial line. This test (a blood gas) will check to see how much oxygen is present in the blood. As your child’s lungs begin to heal, the oxygen level in the blood will begin to improve. This allows us to slowly turn down the ECMO machine, or reduce the amount of oxygen going to the artificial lung and wean off ECMO. The lung and/or heart support, provided by the machine is turned down until it is doing only a small amount of the work. At this time we may try to take him/her off ECMO and measure the level of oxygen and carbon dioxide in the blood to see if the lungs are ready to work on their own.

While your child is on ECMO he/she will receive a medicine called heparin. Heparin will keep your child’s blood from clotting in the ECMO circuit. Heparin may cause your child to bleed while on ECMO. Special blood tests (ACT’s) will be done to check how fast the blood is clotting. When your child NO LONGER NEEDS ECMO, the heparin will be stopped and the time that it takes for your child’s blood to clot, will return to normal within a few hours. Babies are on ECMO for an average of 5 to 7 days. The older child and some infants may be on ECMO for weeks. The doctor and ECMO team will determine how long it should take for your child to get better, but the time needed for possible recovery is not pre-set.