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Reviewed by

Dr. Bhaskar BV

Consultant - Cardiothoracic Vascular Surgery, Heart and Lung Transplant Surgery

Manipal Hospitals, Old Airport Road

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ECMO: How It Works and When Is It Used in Critical Care?

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ECMO (Extracorporeal Membrane Oxygenation) proves a breakthrough in critical care medicine. This life-supporting technology is designed for those patients in whom heart and lung function are impaired and cannot sustain life. When standard treatments fail, ECMO would intervene as an important bridge to life. This understanding of the complex yet important intervention should help patients and families traverse through difficult decisions in health care during critical illness.

What is ECMO in Critical Care?

The heart and lungs work tirelessly to supply oxygen to our body's cells. When these organs fail, life hangs in the balance. ECMO is a specialised technology that temporarily takes over the function of failing hearts or lungs. The ECMO machine works like an artificial heart and lungs outside the body. It pumps and oxygenates blood, giving damaged organs time to heal.

ECMO is not a cure but rather a supportive therapy – it creates a window of opportunity for recovery or treatment of the underlying condition. Most patients require ECMO for days to weeks, depending on their condition and response.

Types of ECMO Support

ECMO comes in 2 main forms:

Veno-Arterial (VA) ECMO: This type supports both heart and lung function. It's used for patients with cardiac failure or combined heart-lung failure.
Veno-Venous (VV) ECMO: This supports lung function only. It's typically used for severe respiratory failure when the heart still works well.

The choice between these types depends on the specific needs of each patient. Your medical team will determine which approach offers the best chance of recovery.

When to Consider ECMO?

Experienced cardiothoracic surgeons in Bangalore reserve ECMO for the most critical cases when conventional treatments and ventilator support proves insufficient. Common conditions requiring ECMO include:

Severe pneumonia
Acute respiratory distress syndrome (ARDS)
Heart attack complications
Cardiac arrest
Bridge to heart or lung transplantation
Pulmonary embolism
Severe flu or COVID-19 complications

ECMO is typically considered when heart function deteriorates and the mortality risk exceeds 80% with conventional therapy. It offers hope in seemingly hopeless situations. Early consideration often leads to better outcomes. Waiting until extreme deterioration may reduce the chances.

Visit Manipal Hospital, in Old Airport Road, for expert ECMO treatment.

How ECMO Works in Critical Care – Life-Saving Heart and Lung Support

Benefits of ECMO

ECMO offers numerous advantages for the patient in the critically ill category.

ECMO allows the natural healing of damaged organs to take place while at the same time providing means to reduce ventilator-induced lung injury associated with conventional treatments.
It significantly augments oxygen delivery and better relieves the heart strain until recovery.
ECMO creates an essential bridge to transplantation when needed and offers hope in extremely critical situations that might otherwise seem hopeless.
It can support patients through conditions that would be fatal without this intervention.
For many patients, ECMO represents the difference between life and death, transforming critical care medicine by providing options where none previously existed.

ECMO: The Procedure

The ECMO procedure begins with careful patient selection. Not everyone will benefit from this intensive therapy. Age, underlying health conditions, and reversibility of the primary disease all factor into this decision.

During cannulation (tube insertion):
Large catheters are placed into major blood vessels
For VV ECMO, tubes connect to large veins
For VA ECMO, tubes connect to both veins and arteries
These procedures typically occur at the bedside in the ICU

Once connected, blood flows from the patient through the ECMO machine. There, it passes through an artificial lung (oxygenator) where carbon dioxide is removed and oxygen is added. The freshly oxygenated blood then returns to the patient.

The entire process requires constant monitoring by specialised ECMO teams. These teams include critical care physicians, perfusionists, nurses, and respiratory therapists who work together 24/7 to manage this complex therapy.

Risks and Complications

Despite its benefits, ECMO carries significant risks like bleeding (the most common complication), blood clots, infection, limb ischemia (reduced blood flow), or even stroke.
These risks must be carefully weighed against potential benefits. The decision to initiate ECMO always involves balancing survival chances against complication risks and is carefully taken by expert cardiothoracic surgeons in Bangalore.

Recovery and Rehabilitation

Recovery depends on age, baseline comorbidities, duration of ECMO support, and severity of the underlying state. Complications arising during the treatment and the character of post-ECMO rehabilitation therapies will also influence recovery trajectories.

Most patients require rehabilitation after undergoing ECMO. Physical therapy aims to restore strength and endurance, while respiratory therapy aims to restore lung function, and speech therapy, if needed, targets impairments that have developed during treatment. While some patients recover completely after ECMO, others may live with long-term consequences from their critical illness. Patience is needed, as this road will be long, lasting for months and not for days or weeks, and will demand the utmost commitment from the patients and their support systems.

Conclusion

The practice of ECMO is perhaps one of the most important advancements in critical-care medicine. It brings hope when physician-directed efforts fail and serves as a bridge for those who often are near death to recovery from severe heart or lung failure. While it does have its risks, ECMO has saved a great many more lives than it has lost.