All about ECMO
Dear Moms and Dads:
This is probably one of the most difficult times in your life. Your child is critically ill and has been placed on ECMO. The ECMO Team is a specialized team consisting of attending physicians, surgeons, fellow, residents, perfusionists, ECMO specialists registered nurses and respiratory therapists. We will be providing around the clock care to your child in the Intensive Care Unit setting . Please do not hesitate to ask any questions. Remember there are no questions that are too big or too small! We are here to support you and most of all, to provide the best possible care to your child. This booklet is dedicated to all parents and families whose lives have been changed by ECMO.
This is probably one of the most difficult times in your life. Your child is critically ill and has been placed on ECMO. The ECMO Team is a specialized team consisting of attending physicians, surgeons, fellow, residents, perfusionists, ECMO specialists registered nurses and respiratory therapists. We will be providing around the clock care to your child in the Intensive Care Unit setting . Please do not hesitate to ask any questions. Remember there are no questions that are too big or too small! We are here to support you and most of all, to provide the best possible care to your child. This booklet is dedicated to all parents and families whose lives have been changed by ECMO.
SOME MORE QUERIES ON ECMO
- What does ECMO/ECLS stand for?
ECMO stands for ExtraCorporeal Membrane Oxygenation; ExtraCorporeal means "outside the body", Membrane is the place where carbon dioxide is exchanged for oxygen, and Oxygenation is the active process of giving oxygen. ECLS stands for Extracorporeal Life Support. These two terms are used interchangeably when talking about ECMO - What is ECMO?
ECMO is a life saving technique that is being used to save children around the world every year. The procedure involves inserting plastic tubes called cannulas into the vein and artery of the neck and/or groin. Once connected to the cannulas, the infant's blood flows by gravity outside of his body throughout the ECMO tubing or circuit. It, then, flows through a roller pump, which are the heart of ECMO and the temporary heart of the patient. The blood is then pumped into the membrane which we call the oxygenator. The oxygenator works like artificial lungs. It provides oxygen and removes carbon dioxide, thus allowing the infant's heart and lungs to "rest" while natural healing occurs. The blood is then warmed and returned to the body. In essence, the ECMO circuit mimics your baby's natural heart and lung functions. - What are some of the reason babies/children are put on ECMO?
There are many reasons a baby can be placed on ECMO. Some of the most common reasons are: Meconium aspiration at birth, respiratory failure, congenital diaphragmatic hernias. Children involved in trauma including drowning, accidents, hydrocarbon ingestion (lighter fluid, turpentine), sepsis or infection, and congenital heart problems are also possible candidates for ECMO - Who can I talk to about ECMO?
There are many parents who have gone through the experience of ECMO. Your nurses will provide you with additional information about the support groups. Social Services, Patient/Family Representatives, and Chaplain are also available. We understand the importance of providing any means of support to you and your family, as this is an overwhelming and difficult time - How long will my child be on ECMO?
The length of therapy is different for each child. Your child's diagnosis, individual response, and progress are all factors that affect the amount of time that he/she is on ECMO. These factors will be evaluated by the physicians on a daily basis and will determine when your child is ready to be weaned and eventually taken off ECMO. The average therapy is usually four days, but the length of time on ECMO varies from patient to patient. - Can I talk to and touch my child while on ECMO?
Yes, it is very important for you as parents to bond with your baby. Although your child is receiving medication for sedation, he/ she can still hear you and knows your voice. We encourage you to touch and stroke your baby softly. Soft music or a tape of your voice can be played at the bedside and is encouraged - Is my child's heart still beating while on ECMO?
Yes, your child's heart is still beating while on ECMO. However, most of the blood that was going through his heart is now going through the ECMO pump. The ECMO pump is now doing a great part of the work of the patient's heart. - Why is my child not breathing while of ECMO?
A special part of the ECMO machine, called the membrane oxygenator, is doing the work of your child's lungs. It is like an artificial lung. Your child is also on a breathing machine called a ventilator that helps to inflate and deflate the lungs just like if your child was breathing on his/her own. Remember, while on ECMO, the patient's heart and lungs are resting, so they can successfully heal and recover - Why does my child look so swollen?
Your child's head, face and sometimes the whole body will become swollen while on ECMO. We carefully move the patient's position throughout the day paying very close attention to the special cannulae (tubes) in the patient's neck. This lack of movement causes fluid to accumulate in different parts of the body, especially the head and face. We also must give IV fluids, which cause your child to look puffy - Is my child in pain during ECMO?
Special medications, such as Fentanyl or Versed are often given to decrease and ease pain and discomfort. Another medication called Norcuron may also be given to prevent your child from moving or becoming agitated. Though it may be difficult to see your child immobile, it is important that you understand that these are all part of treatments used to maximize ECMO therapy and promote healing - Will my child receive blood while on ECMO?
Yes, your child may receive blood or blood components such as platelets, fresh frozen plasma or cryoprecipitate. The physician will write orders daily to keep your child's blood count (hematocrit,platelet, hemoglobin counts) in a healthy range. Blood products will only be given when it is necessary. Blood and/or blood products will not be given unless your consent is obtained. If you wish, you may arrange through the Blood Bank for family and friends to specifically donate for your child; ask your nurse or the ECMO Coordinator if you are interested in blood donation. - Will my child catch the AIDS virus on ECMO?
All blood products given to your baby are carefully screened for the AIDS virus, as well as other viruses and infectious diseases. Because of improved screening procedures by the Blood Bank, every effort is made to make sure that the blood given to your child is the safest - Why is my baby on a special bed?
The ECMO warmer bed is a special bed, which is used during ECMO therapy. The warmer is equipped with a radiant heat, which helps keep your baby warm. It is elevated so that the blood will flow easily from the baby into the ECMO pump - What is Heparin and why is it used on ECMO?
Heparin is a medication called an anticoagulant. The purpose of using heparin while on ECMO is to prevent clotting in the ECMO tubing. Clotting occurs when the blood turns into a jelly-like substance. During ECMO, we want the blood to stay thin and flow easily through the ECMO circuit. The heparin infusion is placed directly into the ECMO circuit. - What are the side effects of Heparin therapy?
The most common side effect of heparin is bleeding. It will take much longer for your child's blood to clot while on Heparin. Your child will be monitored closely by the ECMO Team for bleeding. A daily head ultrasound will be done to make sure there is no bleeding in the infant's head - How do you monitor how fast the blood clots?
The ECMO Specialist will perform a test called an ACT (Activated Clotting Time) every 30 minutes or more frequently, as needed, while on ECMO. This test measures the amount of time in seconds it takes the blood to clot. The physician will write daily parameters for this test. The heparin infusion will be adjusted accordingly to these results. - What are ECMO specialists and what do they do?
For the duration of ECMO therapy, your child will be assigned a registered nurse and an ECMO specialist. ECMO specialists are nurses or respiratory therapists who have undergone extensive training in managing ECMO patients and equipment. He /she will also perform ACT's, manage the ECMO pump, and keep the physicians informed about your child's progress for the duration of the ECMO treatment. - What happens after my child is off ECMO?
Your child will remain in the ICU (PICU or NICU) for continuous close monitoring of his/her progress. As your child gets better, some of the equipment and medications will be removed. If you have newborn baby, he/she may be transferred to the Neonatal Intensive Care Unit (NICU) which is a special intensive care unit for babies; if applicable, your baby will be discharged home from the NICU. Once considered stable, patients other than newborns are moved and followed on the medical floor and discharged home from there. - Will my child have a big scar on his neck?
In most cases, the scar heals well and is very small. Once the surgeon removes the cannulas, the wound is carefully closed and a dressing is placed on it. In time, the scar will fade and is actually not noticeable - Will my child need any kind of follow-up after going home?
Yes, your child will need to return for an ECMO follow-up visit each year. A physical exam will be performed and specific details of physical, cognitive and developmental levels will be assessed. The follow up visits and exams are set up through the Miami Children's Hospital Preventive Medicine Department and will be part of your discharge planning. - What is the ECMO reunion?
Each year, ECMO patients and their families gather for a reunion. It is a fun event that reunites former patients and their families with the physicians and staff. The opportunity to share this special time with each family is a gratifying experience for the ECMO Team.
ECMO Terms
- ACT (Activated Clotting Time)
A test performed to determine the number of seconds it takes for a sample of blood to clot - Cannulation
The procedure in which the ECMO cannulae are inserted into the baby's vein and artery by the cardiovascular surgeon - Decannulation:
The surgical removal of the ECMO cannulae. - ECMO Circuit:
The tubing pack that is connected to the baby during ECMO. - ECMO Specialist
A registered nurse or respiratory therapist who has received specialized training and certification to operate ECMO equipment - Heat Exchanger
The part of the ECMO circuit that warms the blood, before it returns to the patient's body. - Heparin
A medication called an anticoagulant that is used to thin the blood and prevent it from clotting. - Idle:
The minimum blood flow that can run the ECMO circuit as a patient prepares to come off ECMO. When on idle, your child's heart and lungs are doing most of the work on their own. - Membrane Oxygenator
The part of the ECMO circuit that functions like an artificial lung. It supplies oxygen and removes carbon dioxide - Roller Pump:
The part of the ECMO pump that functions like the heart. It pumps blood through the ECMO circuit and back to the patient. - Trial Off period:
The period when your baby/child is taken off ECMO support for short periods of time to test how well the heart and lungs are functioning on their own. If the baby/child does well during this time, he/she can be permanently removed from ECMO - Ventilator:
Also called a respirator. This machine delivers oxygen-filled breaths and inflates the lungs of the patient. - Weaning
The gradual process of decreasing blood flow through the ECMO tubing
