Family Guide to Adult ECMO
Updated August, 1994
ELSO ECMO Parent Manual,
Elaine Braden, RRT, RN
Robert H. Bartlett, MD
Paula Campbell, Surgery
- Dr. Robert Bartlett, MD
was my physician during my ARDS/ECMO crisis. Without his
knowledge and expertise I would not be here today. He is
considered the founder of ECMO, and the University of Michigan's
ECMO program is the largest in the country. We at the ARDS
Support Center are deeply grateful to Dr. Bartlett for the use of
this guide on our website. Bob Berendt,
Dear Family and Friends,
Having a very sick family member being
treated in the strange and overwhelming environment of an intensive
care unit is an extremely stressful situation.
This booklet will provide you with
information, to answer some important questions you may have.
Feel free to ask questions or express
your concerns. There are many people to help you cope with this
The ECMO Team
2920 Taubman Center
1500 E. Medical Center Drive
Ann Arbor, Michigan 48109-0331
What is ECMO?
ECMO stands for ExtraCorporeal Membrane
Oxygenation. It is the use of an artificial heart-lung machine for
patients whose heart or lungs are failing despite all other
treatments. The ECMO equipment functions as a heart (pump) and lung
(providing oxygen). It takes over the work of these organs so they can
rest and heal.
- ECMO is used for children and adult
patients with severe, but reversible heart or lung disorders that
have not responded to the usual treatments of mechanical
ventilation (ventilator), medicines, and extra oxygen.
- Adults who need ECMO usually have
one of the following problems:
- Respiratory failure from trauma or
- Cardiac failure
- ECMO will not cure these conditions;
it does give support and allow time for the lungs/heart to heal.
- We believe this recovery may lead to
the survival of your loved one.
How Long Will ECMO
EMCO is continued until the heart or
lungs recover or until treatment is not effective; it may be a period
of days or weeks.
The length of time on ECMO may be
affected by: the type of lung or heart disease, the amount of damage
to the lungs before ECMO, and other illnesses or complications.
What Are the Risks
Any person who requires ECMO is very
ill and will usually die without it. However, there are risks with
this procedure. The ECMO physician will discuss these with you:
A drug called Heparin is given
to prevent the blood from clotting while it travels through
the ECMO circuit. The amount of heparin given is monitored
closely, but sometimes bleeding occurs. Bleeding can occur
anywhere in the body but is most dangerous when it occurs
around the brain. This could result in permanent brain damage.
If the bleeding becomes too
great, any of the following actions may be necessary:
- Frequent blood transfusions
- Other operations to control
- Discontinue ECMO therapy
Small blood clots may be
introduced into the blood stream of the patient. These clots
can cause serious injury to the patient, damaging vital organs
such as the brain or kidneys.
of ECMO equipment
Although rare, the equipment
required for the ECMO system may fail. An ECMO specialist, at
the bedside 24 hours a day, is trained to respond quickly to
Stroke may occur from bleeding,
or blood clots into the brain. If cardiac support is needed, a
surgical procedure that involves permanently tying off one
carotid artery (blood vessel) is performed. Although there are
two carotid arteries that supply blood flow, brain injury,
including stroke has occurred in some cases.
- An operation is needed to
attach theECMO machine to the patient. This may lead to
infection, bleeding, or vocal cord injury. The function of
the heart or lungs may not improve during the time of ECMO
support. Some patients develop severe blood stream
infections that cause irreversible damage to vital organs.
Risks- Blood Transfusion
Very rarely, serious reactions
can occur, including shock, kidney failure and even death. In
addition, there is a slight risk of acquiring an infectious
disease, such as hepatitis, and a remote risk of AIDS.
Improved donor screening and blood testing procedures make
such problems unlikely.
What You Can Expect
Placing the tubes (catheters) into the blood vessels requires a
procedure done at the bedside by a surgeon and an operating room team.
Your family member is given medications ahead of time for pain control
and sedation. The catheters are connected to the ECMO system.
While your family member is being
supported by ECMO, the ventilator will
remain on at very low settings in order to "rest" the lungs.
is given on a regular basis to prevent any discomfort. Attempts are
made to maintain your family member in an alert, awake state. However,
this is not always possible. Many patients do require heavy sedation
and paralyzation to decrease the amount of oxygen used by the muscles.
ECMO patients are placed on a special
bed. You will notice the bed rotate side to side. This
decreases pressure on the skin to prevent damage and helps move the
secretions in the lungs. It is elevated because gravity plays a part
in the amount of blood that can safely travel through the ECMO system.
We follow a daily
routine that includes a morning chest X-ray and blood tests at
different times throughout the day. The ECMO circuit is used for
drawing blood and for giving medications. The lungs are suctioned
regularly since the patient's cough mechanism is not effective.
is provided through specially formulated solutions administered
through the veins or through a tube into the stomach.
As the heart or lungs improve, the
amount of ECMO support will be decreased over a period of time. As
signs of improvement continue, a "trial
off" ECMO is begun. If this is successful, then ECMO is
discontinued. The patient will remain on the ventilator for support
for several days or weeks, until further improvement takes place.
The ECMO Team
We understand that this is a very
stressful time for you and you may not remember all of our
explanations. Please don't be afraid to ask us the same question more
than once. We are here to help:
physician in charge of your family member's care. Our
physicians are known worldwide for their research and for the
development of ECMO.
This surgeon is
specializing in the treatment of severe respiratory failure
and is the primary manager of patients requiring ECMO, under
the guidance of the attending physician.
of ECMO equipment the minute-to-minute monitoring of ECMO
patients is done by these specially trained nurses and
care and comfort for your loved one. They will often be your
first line of information for the many questions that you
professionals are specialists in ventilator management, make
recommendations to other team members and assist with
residents are medical doctors who are obtaining specialty
training in surgery. Much of the around-the clock-bedside
medical care, under the supervision of the attending physician
and ECMO fellow, is carried out by the resident physicians.
social worker can help you with:
concerns: Insurance, parking, or meals.
issues such as coping with a life threatening illness.
coordinator is a nurse who serves as a resource for you during
and after a hospital stay. She will help answer any questions
or concerns about the plan of care, prepare you to go home,
and be available for follow-up.
How ECMO Works
ECMO substitutes for the function of
the lungs and heart by pumping blood out of the body; oxygen is added
to the blood and carbon dioxide is removed before it is returned to
the patient. This process allows the heart and lungs to rest and
Types of ECMO:
There are two types of ECMO therapy;
venoarterial (V-A) and venovenous (V-V). The terms V-A and V-V refer
to the blood vessels used during the ECMO procedure.
is used in people with blood pressure or heart functioning problems. A
catheter is placed in both a Vein and an Artery. This method gives
excellent support for the heart in addition to the lungs.
In V-V ECMO,
catheters are placed so that blood travels from a Vein and back to
another Vein. The advantage of VV is that the carotid artery does not
need to be tied off as in V-A . Occasionally, patients start out on
V-V and need to be changed over to V-A ECMO.
A large catheter drains blood out to a pump.
This blood is dark because it contains very little oxygen.
A steady amount of blood is pumped
through the ECMO machine each minute. This is referred to as the flow
rate. As your family member improves, the flow rate can be decreased
and more of the blood will get oxygen through the lungs.
The pump pushes blood through a membrane
lung where gas exchange occurs; oxygen is added and carbon
dioxide is removed. The size of the lung is based on the size of the
patient. Sometimes two lungs are needed for adults.
The blood is then warmed by a heat
exchanger , before it is returned to the body.
This blood is bright red because it
You will also see other tubing and
ports for blood withdrawal and drug administration, as well as safety
features, such as a pump regulator or "bladder
box" and a backup power supply.