ECPLA

Overview

Diagram of ECMO circuit

Extracorporeal Membrane Oxygenation (ECMO) is a form of extracorporeal life support used in patients with severe and life-threatening illness that prevents the heart and lungs from functioning properly. ECMO provides prolonged cardiac and respiratory support by removing blood from the body, oxygenating it, and then returning it to the patient.

History

The development of ECMO began in the 1950s with the advent of the heart-lung machine, which was used during cardiac surgery. Over the decades, advancements in technology and understanding of critical care medicine have allowed ECMO to be used in a variety of clinical settings.

Indications

ECMO is typically indicated in cases of severe respiratory failure, cardiac failure, or a combination of both, when conventional therapies have failed. Common conditions that may require ECMO include:

• Acute respiratory distress syndrome (ARDS)
• Cardiogenic shock
• Sepsis
• Congenital diaphragmatic hernia in newborns

Types of ECMO

There are two main types of ECMO:

Veno-Arterial (VA) ECMO

VA ECMO is used primarily for cardiac support. Blood is drained from the venous system, oxygenated, and then returned to the arterial system. This type of ECMO provides both respiratory and circulatory support.

Veno-Venous (VV) ECMO

VV ECMO is used for respiratory support only. Blood is drained from the venous system, oxygenated, and returned to the venous system. It is typically used in cases of severe respiratory failure where the heart function is adequate.

Components of ECMO

The ECMO circuit consists of several key components:

• Cannulae: Tubes inserted into the blood vessels to allow blood to be drained and returned.
• Pump: A mechanical device that circulates blood through the circuit.
• Oxygenator: A device that adds oxygen to the blood and removes carbon dioxide.
• Heat exchanger: Regulates the temperature of the blood.

Complications

While ECMO can be life-saving, it is associated with several potential complications, including:

• Bleeding due to anticoagulation
• Infection
• Thrombosis
• Neurological injury

Weaning and Decannulation

Weaning from ECMO involves gradually reducing the support provided by the machine as the patient's heart and lungs recover. Decannulation is the process of removing the cannulae once the patient no longer requires ECMO support.

Related pages

• Cardiopulmonary bypass
• Intensive care medicine
• Mechanical ventilation