Extracorporeal Membrane Oxygenation for Infants (ECMO)

What is Extracorporeal Membrane Oxygenation for Infants (ECMO)

Extracorporeal membrane oxygenation is a treatment that uses a machine called an oxygenator to do the work that the heart and lungs normally do. This treatment may be used:

  • Before an operation to give the heart and lungs time to rest.
  • After an operation to give the body time to heal.
  • In cases of severe illness from disease.

Normally your blood gets oxygen from the lungs. In this treatment blood flows into the oxygenator, which adds oxygen to the blood. The blood is warmed. Then, the blood is returned to the body. The oxygenator makes sure the brain, liver, and kidneys get the oxygen they need. When the heart and lungs are ready to work again, the oxygenator is removed.

Why would my baby need ECMO?

ECMO may be needed for various reasons, such as for:

  • Lung problems, such as:
    • Respiratory distress or respiratory failure at birth. This means your baby was born with lungs that do not work correctly.
    • Congenital diaphragmatic hernia. This is when the divider between the lungs and the organs in the abdomen (diaphragm) has not formed correctly at birth. As a result the organs in the abdomen can push into the chest and against the lungs. When this happens, the lungs cannot work as they should.
    • Meconium aspiration syndrome. This is when your baby breathes in fluid that surrounds him or her in the womb (amniotic fluid) that has been contaminated with your baby’s first waste products (meconium). This can cause the lungs to swell and block the airways.
    • Pulmonary hypertension. This is when pressure in the lung blood vessels is higher than the pressure of the blood exiting the heart. This prevents the lungs from working normally.
    • Pneumonia. Pneumonia is an infection of the lungs. ECMO may be needed in severe cases.
  • Heart problems, such as:
    • Heart failure. This is when the heart cannot pump blood the way it should.
    • Heart surgery. ECMO may be needed before or after the operation.
    • Heart transplant. ECMO may be needed while waiting for a heart to be available. It may also be required after the transplant.

What are the different types of ECMO?

Types of ECMO include:

  • Venoarterial ECMO. This helps both the heart and the lungs. Blood is taken out of the body as it returns to the heart through the veins. The tube that takes out the blood is called a cannula. The blood is oxygenated and pumped back into body through an artery.
  • Venovenous ECMO. This type of ECMO helps only the lungs. The cannula is put in a vein to remove blood. The blood is oxygenated and returned to the body in the same vein. The oxygenated blood flows into the heart, which pumps it out to the body.

What happens during ECMO?

During ECMO, the oxygenator will be next to your baby’s bed. Your baby will be watched very closely by a team of health care providers.

Medicines

Medicines will be given through one or more IV tubes. A needle connected to a plastic tube will be put in one of your baby’s blood vessels. Medicines will flow into the body through the IV tube. Medicines may include:

  • A medicine to make your baby fall asleep (general anesthetic).
  • A medicine to prevent blood from clotting.
  • A medicine to help your baby relax (sedative).
  • Pain medicine.
  • Medicines to treat an infection or to lower blood pressure.

Testing

Tests are often done more than once. Tests may include:

  • Blood tests and X-ray exams.
  • An ultrasound exam of the heart (echocardiogram) to evaluate heart function.
  • An ultrasound exam of the head to detect bleeding into the brain.

Tiny monitors will be put on your baby’s body. They are used to check your baby’s heartbeat, oxygen level, and blood pressure.

Breathing help

A breathing tube will be put through your baby’s nose or mouth to keep the air passage open. A breathing machine (ventilator) may be used to keep the lungs inflated.

Feeding

Your baby cannot eat normally during ECMO, so nutrition will be delivered through one of the IV tubes. Sometimes a small amount of nutrition may be given through a tube inserted directly into your baby’s stomach.

How long will my baby be on ECMO?

The oxygenator usually is used for a short time. However, it may be used for as long as a few weeks.

What are the risks and complications of ECMO?

Generally, ECMO is safe. However, problems may occur, including:

  • Bleeding.
  • Infection.
  • Reactions to blood transfusions.
  • Problems with the ECMO machine.
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