Medical knowledge, Patient Education

Extracorporeal Membrane Oxygenation

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Extracorporeal membrane oxygenation (ECMO) is a treatment that involves connecting you to a life-support machine. You may need ECMO if your life is in danger because your heart or lungs are not working properly.

During ECMO, tubes are inserted into your blood vessels and then guided to your heart. One tube removes blood returning to the heart. The blood is pumped into an artificial lung outside the body (extracorporeal membrane), where oxygen is added to the blood. The blood is then pumped back into your heart.

ECMO may last for days or weeks. During this time, the ECMO machine will take the place of your lungs and possibly your heart. This gives your lungs and heart time to rest and recover. Health care providers may also correct lung or heart problems during this time. ECMO may be needed if:

  • You have a severe infection.

  • You had a heart attack.

  • You have heart failure.

  • You have severe heart valve disease.

  • You are waiting for a heart or lung transplant.

  • You had or will have heart surgery.

  • You have acute respiratory distress syndrome (ARDS).

  • You have a blood clot in the lungs.

You will be monitored closely in a hospital intensive care unit during and after this treatment. You will stay on an ECMO machine only as long as it is needed for life support. Recovery after ECMO can take several weeks or months.

What are the risks?

Generally, this is a safe treatment. However, problems may occur, including:

  • Bleeding. You will get a blood-thinning medicine to prevent clots while you are on an ECMO machine. This may increase your risk of bleeding.

  • Kidney damage.

  • Infection.

  • Damage to a leg or other limb from poor blood flow.

  • Blood clots.

  • Stroke.

  • Brain damage.

What happens before treatment?

Surgery safety

Steps will be taken to help prevent infection. These steps may include:

  • Removing hair at the surgery site.

  • Washing skin with a germ-killing soap.

  • Giving you antibiotic medicine.

General instructions

  • You may be attached to a breathing machine (respirator).

  • You may be given medicine to control pain.

What happens during the treatment?

  • An IV will be inserted into one of your veins.

  • You will be given one or both of the following:

    • A medicine to help you relax (sedative).

    • A medicine to numb the area (local anesthetic).

  • Small incisions will be made in your legs, neck, or chest.

  • Thin tubes (cannulas) will be placed into arteries or veins, depending on the type of ECMO you need. There are two types:

    • Veno-venous ECMO. Cannulas are put into a large vein. This type may be needed if your lungs are not working well enough to get oxygen into the blood.

    • Veno-arterial ECMO. One cannula is put into a large artery, and another cannula is put into a large vein. This type may be needed if the lungs and heart are not working properly.

  • Blood will start to flow to the ECMO machine and then will be returned to your body.

  • During treatment, you will:

    • Have your blood pressure, heart, and oxygen level monitored.

    • Continue to receive sedatives and pain medicine.

    • Be given a blood thinner (heparin) to prevent blood clots.

    • Have X-rays and other imaging tests to check the position of the cannulas and the health of your lungs.

    • Have blood tests to check your complete blood count, blood oxygen level, and kidney function.

    • Be checked often for any sign of brain damage.

    • Have your limbs checked often for blood flow.

    • Receive nutrition through your IV or through a tube placed through your nose.

ECMO will continue until your treatment team feels it is safe to stop ECMO. To stop treatment:

  • The support from the ECMO machine will be gradually decreased.

  • The cannulas will be removed, and the incisions will be closed.

  • You may need to stay on a ventilator for breathing assistance.

The procedure may vary among health care providers and hospitals.

What can I expect after the treatment?

  • You will be monitored closely.

  • You may need to stay in the hospital for further treatment before returning home.

Follow these instructions at home:

Incision care

Two stitched incisions. One is normal. The other is red with pus and infected.

  • Follow instructions from your health care provider about how to take care of your incisions.

  • Check your incision areas every day for signs of infection. Check for:

    • Redness, swelling, or pain.

    • Fluid or blood.

    • Warmth.

    • Pus or a bad smell.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider.

  • Ask your health care provider if the medicine prescribed to you requires you to avoid driving or using machinery.

  • Do not take baths, swim, or use a hot tub until your health care provider approves.

  • Drink enough fluid to keep your urine pale yellow.

  • Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco, and vaping devices, such as e-cigarettes. If you need help quitting, ask your health care provider.

  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

  • Keep all follow-up visits. This is important.

Where to find more information

  • American Thoracic Society:www.thoracic.org

  • Extracorporeal Life Support Organization: www.elso.org

Contact a health care provider if:

  • You notice any symptoms your health care provider directed you to report.

  • Any incision has signs of an infection.

  • You have a fever.

  • You have nausea or vomiting.

  • You have swelling in your ankles or legs.

  • You have pain in your legs.

Get help right away if you:

  • Have chest pain that spreads to your jaw or arms.

  • Are short of breath.

  • Have a fast or irregular heartbeat.

  • Have sudden weakness.

  • Have a change in your vision or ability to speak.

  • Have a seizure.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

  • Extracorporeal membrane oxygenation (ECMO) is a procedure to connect you to a life-support machine.

  • You may need ECMO if your life is in danger because your heart or lungs are not working properly.

  • While you are on the ECMO machine, health care providers will try to correct your lung or heart problem. The ECMO machine will breathe and pump blood for you while you recover.

  • ECMO may last for days or weeks, depending on the reason you need it and your response to treatment.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.

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