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ECMO stands for Extra-Corporeal Membrane Oxygenation.
ECMO is very similar to the heart and lung bypass machine used in a theatre during open-heart surgery. It will provide blood with enough oxygen to support the body’s organs until the heart and/or lungs begin to work on their own.
When a child is very sick, ECMO may be used when other less invasive therapies have failed. Some children who may benefit from ECMO are:
children who have severe lung disease and not responding to ventilation, medicines and extra oxygen
children with severe heart failure before or after surgery.
ECMO will only be offered to children that have a condition that is reversible. The doctors will discuss the reason why your child needs ECMO support.
It is important to understand ECMO is not a cure, but will give the heart and/or lungs time to recover.
Since 2010, the Alder Hey ECMO Service has developed from a Perfusion-led service for post cardiotomy patients to a large multi-disciplinary ECMO Team of professionals from cardiac services, theatre, Perfusion and Paediatric Intensive Care.
The Landmarks of Alder Hey ECMO Service Development
VA ECMO – (Veno-Arterial) A cannula is placed into both an artery and a vein, providing support for both the heart and lungs.
VV ECMO – (Veno-Venous) A single cannula is placed into the vein, providing support for the lungs only. Some children may need to be changed over to
VA ECMO if their heart is not pumping well.
A short operation on CCU is needed to insert a cannula. Your child will have an anaesthetic during this procedure so they will not feel pain.
ECMO works by taking blood with little oxygen from the heart through a cannula placed in a vein. This blood is pumped through an oxygenator which acts as an artificial lung. The blood now containing oxygen is then pumped back into the body and this is a continuous cycle.
Your child will remain on a ventilator, but at lower settings than before. We will give your child pain killers and sedation so that they are comfortable and pain free. We will constantly be assessing and reviewing how much sedation and pain relief your child needs.
Doctors will examine your child to assess their progress every day. They may not be able to discuss the care with you there and then, but Intensive Care Consultants or Cardiac Surgical Consultants will update you.
Doctors may also perform scans of the heart called an ECHO. This is to assess how well the heart is pumping. Scans may have to be compared so you might not be able to receive an immediate update.
Other scans to assess neurological function (brain) may be performed, such as head ultrasound and EEG.
We will always keep you informed with the reasons for a scan and the results.
Your child will be fed via a nasogastric tube. If they are not absorbing feeds, they will be given nutrition called TPN through a vein.
If you are breastfeeding we will encourage you to express milk so we can store it to use later.
Your bedside nurse can give you further information about this. A Dietician will be involved in your child’s care to ensure they are getting enough calories for their needs.
This varies as ECMO support can depend on their original diagnosis and why ECMO support is needed. For most children it is needed for three to seven days, but can be for longer. Each child condition is different. Some of the differences could be the type of lung, heart disease or if there was any damage to either organ before starting ECMO.
Sometimes it becomes clear that a child’s heart and/or lungs will not get better and ECMO is not helping. If this is the case it will be fully discussed with you at the time.
After careful evaluation by the Medical Team it may be decided to reduce the amount of ECMO support and allow the heart and lungs to take over. This can be a slow process that can take many hours. During this time ventilation will be increased and medicines may be required to help the heart to pump.
Once ECMO is giving minial support and a child remanis stable, we start a 'Trial-off' period. This involves clamping the circuit. It is when the circuit tubes are clamped to stop the ECMO, so that the machine no longer does the work of the heart or lungs, the child's body has to take over the work. If a child remains stable, the cannula will be removed in a short operation.
They will still need intensive care support, and may appear to be sicker because their heart and lungs have to work without ECMO support. You will be kept fully updated by the doctors and the bedside nurse.
There are benefits and risks related to EMCO and it is a balance between the two that has to be considered. A child that needs ECMO is very ill, and without it would normally die.
You play an important part in your child’s care. We encourage you to visit your child whilst they need ECMO support. There are things you can do to help, please talk to your bedside nurse or ECMO Nurse Specialist to see how you can be involved.
This may be:-
It is important to remember to look after yourself. You need to make sure you eat regularly take enough fluids and get some rest. This is especially important if you are expressing breastmilk.
Don’t feel guilty if you cannot spend every moment at the bedside because of other family commitments or if you are exhausted.
Your child will receive the upmost care from the dedicated team in CCU. If you need any help with any personal issues please ask. We can help you, if not directly, but by directing you to the appropriate people. Part of our job is caring for you too.
There are many people involved in the care of your child whilst they receive ECMO support. There will be two nurses looking after your child at any one time. They will be at your child’s bedside at all times.
The ECMO Nurse Specialist
Will monitor your child and the ECMO equipment.
The Intensive Care nurse
Will look after your child’s general needs.
ECMO Co-ordinator and
Support and oversee the ECMO Specialists
Will perform the operations to insert and remove the ECMO cannulas
The Doctor who is responsible for the whole CCU. They lead the team who will be responsible for your child’s care
Doctors who monitor day to day care and work closely with the Intensivists, Cardiothoracic Surgeon and ECMO Nurse Specialists
To perform ECHO’s and ECG
Nutrition & Dietetics
Will monitor nutrition
Checking medicines everyday
Ensuring that lungs remain clear
Taking x-rays and ultrasound scans
If your child requires PD/ CVVH
Providing blood and blood products
Continuous Veno-Venous Haemofiltration – a therapy performed by an artificial kidney machine
The plastic tubes by which blood is taken and returned to the body
Short for Echocardiogram. This is a scan of the heart (like a pregnancy scan) to see how well the heart is working
Extracorporeal Membrane Oxygenation
Electroencephalogram. This measures the electrical activity in the brain and can help detect fits/seizures
A scan (like a pregnancy scan) of the brain to look for bleeds.
A feeding tube which passes through the nose to the stomach to allow us to feed your child
A therapy performed to replace the work of the kidneys
Total Parenteral Nutrition
Nutrition delivered through a vein when the child is unable to absorb feeds into their stomach
A breathing machine that supports the lings and takes over the work of breathing
Alder Hey Children's Charity