Extracorporeal membrane oxygenation (ECMO)
Extracorporeal membrane oxygenation (ECMO) is a temporary life support system. We use this system for people whose lungs have stopped working properly.
The lungs can stop working properly for several reasons. An example is a severe infection that damages the lungs and causes acute respiratory distress syndrome (ARDS). ARDS is a life-threatening condition when the lungs cannot give the body's vital organs enough oxygen.
The ECMO machine temporarily does the work of the lungs and gives them time to heal.
To start ECMO, we insert 2 tubes (cannulas) into 2 large veins and place them near the heart. Blood is pumped from 1 tube through an artificial lung, where oxygen is added and carbon dioxide is removed. This oxygen-rich blood then passes back into the blood stream through the other tube.
Benefits of ECMO
We might recommend ECMO if:
- someone is seriously ill with lung failure
- they have not responded to other methods to help them breathe, such as ventilators (breathing machines)
ECMO is only used if doctors believe that:
- it might be possible to treat the person's lung failure
- they are likely to die without this life support system
A recent trial of ECMO showed that 57 out of 90 (63%) people with severe ARDS survived if they were treated with ECMO.
Risks of ECMO
To start ECMO, we put large tubes near the heart. The blood needs to be thinned to stop it from clotting. This has some risks, such as:
- bleeding (including bleeding into the brain)
- clotting in large blood vessels
- brain damage
- damage to the blood vessels
Anyone who is unwell enough to need ECMO has a higher chance of dying.
Other treatment options
There are no other treatment options to ECMO. By the time that a person needs ECMO, we have tried all other types of breathing support and they have not worked.
What happens during ECMO
We put 2 or 3 large tubes in the groin or neck. The blood is then taken out of the body, passed through an artificial lung and returned to the body. We give blood thinning medicines to prevent the blood from clotting in the tubes.
ECMO is a continuous process. The average time that people spend on ECMO is 2 weeks, but this can be much longer (months).
Pain during ECMO
We give the person powerful painkillers and sedatives (medicine with a calming effect) during ECMO. If we do any procedures, we use local anaesthetic (medicine to make the area numb and pain-free).
How we stop ECMO
When the lungs have recovered enough for a ventilator to be used by itself, we stop ECMO and remove the tubes.
People who have ECMO usually spend a lot of time in the intensive care unit. They need to stay in hospital to continue their recovery. This can take weeks or even months.
If there is no hope of someone recovering, the doctors will talk to family members about stopping ECMO and allowing a peaceful death.
Giving your permission (consent)
When we think about starting ECMO, the person is unconscious because they're too sick to be awake.
Family members cannot give permission (consent) on the person's behalf. However, the intensive care doctors talk to family members about the person's treatment, and explain the risks and benefits of ECMO.
You can read our consent policy for more information.