Extracorporeal Membrane Oxygenation (ECMO)

Extracorporeal membrane oxygenation (ECMO) involves pumping blood outside of the body to a heart-lung machine. The equipment eliminates carbon dioxide and returns oxygen-rich blood to the body. Blood travels from the right side of the heart to the heart-lung machine. It is then rewarmed and returned to the body. ECMO allows blood to flow around the heart and lungs. This permits the heart and lungs to rest and recover. ECMO is a type of extracorporeal life support (ECLS). It is used to treat life-threatening cardiovascular and respiratory disorders. ECMO may treat COVID-19, acute respiratory distress syndrome (ARDS), and other infections. This blog delves into the complexities of ECMO, including uses, types, benefits, hazards, and advancements.

The ECMO machine is composed of several key components:

• Pump: Circulates blood through the circuit.
• Oxygenator: Adds oxygen to the blood and removes carbon dioxide.
• Cannulas: Big tubes that are put into blood vessels to help blood move to and from the ECMO machine.
• Heat exchanger: Controls blood temperature to match the patient's body temperature.

Why it's done

ECMO can help persons with heart or lung failure. It may also be used to treat persons who are awaiting or have already received a heart or lung transplant. It is sometimes used when other forms of life support have failed. ECMO does not treat or cure illnesses. However, it can provide temporary relief when the body is unable to produce adequate oxygen and blood flow to the tissues. ECMO can be used for the following heart conditions:

• Complications following a heart transplant.
• Heart attack, also known as acute myocardial infarction.
• Cardiomyopathy is a disease of the heart muscle.
• Cardiogenic shock occurs when the heart fails to pump enough blood.
• Hypothermia refers to a low body temperature.
• Sepsis.
• Myocarditis is the inflammation and swelling of the heart muscle.

ECMO can be used for the following lung conditions:

• Acute respiratory distress syndrome, or ARDS.
• A pulmonary embolism is a blood clot that blocks and stops blood flow to an artery in the lung.
• COVID-19.
• Meconium aspiration occurs when a fetus breathes in waste products while still in the womb.
• Hantaviral pulmonary syndrome.
• High blood pressure in the lungs is known as pulmonary hypertension.
• Congenital diaphragmatic hernia is a hole in the muscle that connects the chest and abdomen.
• Influenza, also known as the flu.
• Pneumonia.
• Respiratory failure.
• A severe allergic reaction known as anaphylaxis.
• Trauma.

Benefits

An ECMO system can save the lives of critically ill people by supporting their lungs and hearts. This may have the following effects:

• Reduces the strain on the heart and lungs, allowing these organs to heal.
• Keeps a patient alive during surgery or another medical procedure.
• Helps a person while they are waiting for a transplant.
• Helps infants who were born with heart problems or underdeveloped lungs.

Risks 

While an ECMO machine is a valuable medical tool, it also carries risks, some of which are significant.

• Clotting problems: Anyone receiving ECMO must additionally take blood thinners to reduce the risk of clot formation. Clots could potentially get caught in the ECMO circuit, disrupting blood flow.
• Infection: Any break in your skin increases your risk of infection, and the tubes of an ECMO circuit can allow an infection to enter your circulation directly. This can allow an infection to spread more easily throughout your body.
• Bleeding: Tubes must enter major arteries and veins, which increases the risk of bleeding.
• Low or varying blood oxygen levels: Normally, your blood oxygen level should range between 95% and 100%. In general, the ECMO target range is 86% to 92%. Maintaining a consistent blood oxygen level throughout your body might also be difficult.
• The ECMO circuit failed: A mechanical failure in any portion of the ECMO circuit can cause the entire system to cease. This can be life-threatening.
• Stroke: Stroke can develop as a result of either spontaneous bleeding in the brain during ECMO assistance or clots in the circuit that make their way to the brain. This can be life-threatening.

When should ECMO machines not be used?

ECMO is less likely to benefit elderly patients. Your doctor can help you understand the dangers and benefits of getting older. There are numerous conditions or situations in which ECMO is not a possibility. This includes:

• When a person's heart, lung, or circulatory problems are irreversible or cannot be treated with a transplant.
• People who have suffered damage to other vital organs, such as the liver or brain.
• Cancer has spread from its original site.
• Uncontrolled internal bleeding, particularly in the head, or injuries that may result in uncontrolled bleeding.

Conclusion

Extracorporeal Membrane Oxygenation (ECMO) is a significant improvement in life support technology. It revolutionized the treatment of severe cardiac and respiratory failures, saving countless lives. While not without problems, continued advances in ECMO technology, procedures, and training point to a brighter future for critical care patients. Understanding ECMO allows us to grasp its importance as a cornerstone of current intensive care medicine. For information, visit SHALBY Sanar International Hospitals in Gurugram.