Friday, December 28, 2007

ECMO (Extra Corporeal Membrane Oxygenation)

ECMO or extra corporeal membrane oxygenation is used when a child's lungs and/or heart are not able to perform their usual job. For whatever reason they are not able to do their work and the doctors caring for the child believe that ECMO can help, the ECMO machine provides support for the child allowing time for the lungs and/or heart to recover, repair, and develop for themselves. It works like a heart lung bypass machine similar to the one that is used in open heart surgery. Extra corporeal means "outside the body". The actual reality of the matter is this: it works like a heart and a lung for the child with a reversable heart or lungs disease. It can be used for a period of up to about two weeks.

A child would need ECMO for the following reasons:

1. Children with very severe lung disease not responding to the usual treatment of mechanical ventilation, medicines and extra oxygen.

These can include ARDS, pneumonia, trauma, asthma, aspiration, acute respiratory failure, auto immune disorders, oncology, sickle cell crisis or anything that can compromise the lungs.

2. Children who are waiting for heart or lung surgery and need the help of a bypass machine while they are waiting.ECMO works by circulating the unoxygenated blood from a vein in the neck into the artificial oxygenator (or artificial lung)where it gets rid of the carbon dioxide and receives oxygen. It is then put back into the body via an artery also in the neck. The child will also be on life support or a ventilator.

When a child is placed on ECMO, every effort is made to get them off as soon as possible. Each patient will be assigned a team of health care workers including Doctor, ECMO specialist, perfusionist, Respiratory Therapist, ECMO RN, and various other support people. When a child is placed on ECMO it is to save their life because nothing else has or will work. In other words, the child would die if it were not for the ECMO. A child will be placed on full support to start with. As healing begins to take place, settings will be turned down as the body is able to function better on it's own. The child's improvement is measured by blood samples, chest movement, improved chest x-rays and improved heart function. When this is seen, the ECMO flow will be gradually reduced to a stage where your child is actually taken off of ECMO for a short period of time. This time will be increased until the ECMO support is determined to no longer be needed. The child may still need full ventilator support. They may also need extra medications. Of course, all of this will be reduced as the child gets better.It is a very frightening thing to have your child placed on ECMO. As a parent, it is important to take care of yourself so that you are able to take care of your child when he or she gets better and will need you. It has been suggested that a parent keep a diary of all that goes on in order to know what questions to ask and to keep busy. This is a life and death situation. Gather your support people about you and allow yourself to use them.

ECMO-a last resort treatment that saves lives.


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