Extracorporeal membrane oxygenation (ECMO) provides prolonged respiratory and cardiac support to patients whose lungs and heart are so severely diseased or damaged that they cannot normally function on their own. There are a handful of doctors in the U.S. who are most experienced in ECMO, and Jefferson’s Dr. Nicholas Cavarocchi is one of them.
An ECMO machine is similar to a heart-lung machine. It consists of the:
- Venous cannula – Catheter is inserted into a vein to drain the blue blood (without oxygen)
- Arterial cannula – Catheter is inserted into a vein for red blood return (with oxygen)
- Pump – Can be adjusted to achieve the desired blood flow
- Oxygenator – Pumps the blood through an artificial lung, which helps circulate the blood through the body
- Water heater – Blood is warmed to body temperature and pumped throughout the body
Under Dr. Cavarocchi's leadership, Jefferson's well-trained adult ECMO team of ICU physicians, physician assistants, RNs, perfusionist, respiratory therapist and certified critical care transport nurses have achieved significant expertise.
What are the Different Types of ECMO?
When your loved one is placed on ECMO, blood will flow through the ECMO machine tubing where it receives oxygen from the machine's artificial lung. There are two types of ECMO:
- In veno-arterial (VA) ECMO, one cannula will be placed in a large vein and another in an artery. VA is used when there are problems with the heart, lungs or both.
- In veno-venous (VV) ECMO, a double tube is placed in a large vein. VV is used when there are lung problems only.
These cannula are connected to a specialized ECMO machine, which avoids the serious side effects of bleeding and hemolysis. Our intensive care staff closely monitors each patient during the procedure to ensure that they are stable and comfortable. Standarized protocols are followed by highly trained critical care nurses, mid-level providers and physicians to support the care.
How Long is a Person Kept on ECMO?
Jefferson uses highly advanced pumps and oxygenators specially designed and proven to minimize potential complications.
As your loved one's health improves, less support will be needed until the heart and/or lungs are able to function on their own. On average, the patient is on ECMO for a week to 10 days. Respiratory patients may be on ECMO for longer. A breathing machine is still needed after taken off ECMO.
ECMO is commonly used in children and has more recently been introduced in children and adults with the H1N1 flu and as a type of bridge to recovery.
What is ECMO Used For?
Respiratory diseases and conditions potentially treatable by ECMO are:
- Aspiration pneumonia
- Acute respiratory distress syndrome (ARDS)
- H1N1 Influenza A respiratory failure
- Sepsis-related ARDS
- ARDS in obstetric patients
- Pneumonia (viral, bacterial, atypical)
- Pancreatitis with SIRS
- Burns (smoke inhalation)
- Pulmonary embolism
- Tricyclic antidepressant overdose
- Rescue therapy for a failed lung transplant (Tx) or as a bridge to Lung Tx
Cardiac diseases supported by ECMO can include:
- Cardiogenic shock any cause except sepsis
- Acute myocardial infarction
- Refractory arrhythmia
- Post-partum cardiomyopathy
- Pulmonary embolus
- Post-cardiotomy failure
- Acute or chronic heart failure
- Post-transplant organ failure
- Hypothermic arrest
- Bridge to VAD or transplant
What are the Results of ECMO?
With the introduction of Dr. Cavarocchi's expertise, leadership and involvement of a team approach, Jefferson's adult ECMO program survival rates far exceed national reported rates. Patients are placed on ECMO earlier than usual, which improves their chances of either being successfully weaned from ECMO or having surgery with fewer complications.
If you still have questions about ECMO, please call 215-955-6925. To schedule an appointment with a cardiologist or pulmonologist, please call 1-800-JEFF-NOW.