Extracorporeal Membrane Oxygenation (ECMO)

Extracorporeal Membrane Oxygenation (ECMO)

What is ECMO?

ECMO stands for extracorporeal membrane oxygenation. ‘Extracorporeal’ is the medical term for anything outside the body, and ‘membrane oxygenation’ means adding oxygen to the cells. The individual is put on ECMO when their heart and lungs aren’t working properly. It is an advanced, complex procedure in which blood is pumped out of the body and into a machine which adds oxygen to the blood to increase oxygen concentration and removes carbon dioxide and then pumps the blood back into the body. ECMO is a form of life support used to support patients in need of critical care.

How does ECMO work?

During treatment with ECMO, a patient’s blood is taken out of the body via a blood vessel (from the neck, chest or groin). It then flows into a tube and is pumped into a machine which adds oxygen and removes carbon dioxide directly to and from the blood. It performs the exchange of gases which the lungs normally do. The machine then pumps the oxygenated blood back into the patient’s body.

Which patients can ECMO help?

ECMO is used as a treatment for patients with serious lung conditions. The blood can bypass both the lungs and the heart if needed and is often used in patients recovering from heart attacks, lung infections or trauma.

Conditions treated with ECMO include:

Acute respiratory distress syndrome (ARDS)

Causing damage to the lungs, ARDS restricts the amount of oxygen that enters the blood and the amount of carbon dioxide that can be removed. ARDS can be caused by:

• Bleeding in the airway
• Drowning or aspirating liquid into the lungs
• Inhaling hot air
• Inhaling smoke, fumes, and toxic chemicals
• Pancreatitis
• Respiratory infections (including coronavirus, flu, pneumonia)
• Sepsis.

Injuries to the heart

Heart injuries can be caused by a heart attack or trauma from an accident.

Pulmonary embolism

A pulmonary embolism is a blood clot which travels to the lungs and stops blood flowing properly through the lungs leading to heart or lung failure.

Transplants and surgeries

ECMO can be used on patients who are waiting for a specific procedure to take place, such as those waiting for heart or lung transplants. It can also be used to keep patients who are donating organs alive for as long as possible. It can also help patients recover from major surgery, such as complex heart and lung surgeries.

What at the benefits associated with ECMO?

ECMO is a lifesaving procedure for critically ill patients. It performs the function of the lungs and heart when the body is not able to. It can support the body by performing these functions, so the heart and lungs are able to heal properly.

It is also used to keep patients who are undergoing complex surgeries, either on the heart, lungs, or other procedures, alive. It is also used on patients waiting for transplants.

What at the risks associated with ECMO?

ECMO is a lifesaving tool but is also associated with risks. These include:

• Bleeding: As ECMO involves tubes into major blood vessels, there is a risk of bleeding.
• Blood clotting issues: Patients on ECMO must take blood thinners to reduce the risk of clots forming and entering the ECMO machine and preventing blood flow.
• Infection: Any surgery raises the risk of infection, particularly when tubes are inserted directly into the blood stream.
• Low blood oxygen concentration: Maintaining an oxygen level that is stable throughout the body is challenging.
• Stroke: If a clot forms and travels to the brain, it can cause a life-threatening stroke.

ECMO is generally not used in older patients due to greater age-related risks. It also cannot be used in patients with:

• Cancer which has spread
• Uncontrolled internal bleeding
• Unrepairable lung, heart or circulatory problems or damage to critical organs such as the brain or liver.

ECMO at Cleveland Clinic Abu Dhabi

Cleveland Clinic Abu Dhabi is one of only a handful of facilities offering ECMO in the UAE. The hospital was the first in the UAE to perform an awake ECMO retrieval.

ECMO is an advanced, lifesaving machine for critically ill patients and those receiving complex care. In addition to receiving treatment with ECMO, patients require round-the-clock care and attention from a team of multidisciplinary, highly skilled caregivers.