Complications of ECMO

ECMO is an extreme, life-saving procedure. Your child was placed on ECMO because of the seriousness of their disease. However, ECMO is not without risks. The ECMO doctor will discuss the risks and/or complications with you when you give permission to place your child on ECMO. Here is a review of the possible complications.

1. The most common complication is bleeding. This is often due to the heparin that is given to prevent clotting of the blood. Sometimes this can lead to internal bleeding. The most serious place in which bleeding may occur is in the brain. Bleeding in the brain may lead to brain damage. If bleeding of any kind occurs, the problem will be discussed with you in detail.



2. The surgical procedure used to place the cannulas into the neck or groin requires clamping of veins (internal jugular or femoral vein) or an artery (right carotid artery or femoral artery). The right carotid artery is one of the four arteries that supply the major blood flow to the brain. When one of the arteries is used for ECMO, the other three arteries take over and carry plenty of blood to the brain. After ECMO, the vein will be tied and closed.



3. Your child may be receiving transfusions of blood and other blood products. This may slightly increase the risk of infection from hepatitis and HIV (the virus that causes AIDS). All blood products are screened carefully before use, but purity cannot be absolutely guaranteed. Your child will be monitored for any signs of infection from blood transfusions.



4. The ECMO machine that your child is on may fail or malfunction and we may not be able to restart the therapy. The ECMO specialist, the doctor, the bedside nurse and the respiratory therapist are trained to take care of any problems that may happen. Your child may have to be off ECMO while the problem is being corrected. During this time, your child will receive the required support needed. In most cases, but not all, the ECMO machine can be repaired or replaced and ECMO support restarted.



5. Whenever a cannula is inserted in a blood vessel, there is an increased risk of infection. Your child may receive antibiotics as a precaution or may have them added if an infection happens. We will watch very carefully for signs of infections.



6. Your child may gain considerable weight while on ECMO. This is due, in part, to the fact that your child does not move much while critically ill. This allows fluid to settle in the tissues and make him/her look "puffy." This is called edema. This will go away a few days after he/she is off ECMO and moves around. If the extra fluid is causing difficulty in weaning from ECMO, we can give medications (Lasix,) or use an artificial kidney (hemofiltration) to remove the fluids quickly.



7. Small blood clots or air bubbles can get into the blood stream of the ECMO circuit. There is a safety device that should catch most clots and air bubbles, but there is a chance that clots or bubbles may reach your child.



8. There is a chance that a complication may happen that makes it impossible to keep your child on ECMO. If it is too early in your child's recovery, he/she may not survive off of ECMO.



9. Your child and the ECMO machine are monitored by an ECMO surgeon, an Intensive Care doctor, an ECMO specialist and an ICU nurse. We take every possible precaution to decrease the risks of ECMO. If a problem of any type occurs, we will discuss the issue with you and consider what plan is best for your child.