ECMO stands for Extracorporeal Membrane Oxygenation and is also known as ECLS (Extracorporeal Life Support). It is a therapy/machine that supports patients whose heart and/or lungs aren’t working properly. Blood is taken out of the body through a tube called a “cannula.” It then goes through a pump and an “oxygenator” where the blood is given oxygen and carbon dioxide is removed. Last, the blood goes back into the body through a 2nd cannula. 

When a person’s heart and/or lungs are sick, the medical team will first try and treat them with medicines and a breathing tube (ventilator). When these things aren’t enough and the heart and/or lungs are too sick to support the body’s needs, ECMO is used. There are a number of reasons why the lungs and/or heart can get sick. The person may have had a viral illness and gotten a lung infection or have a history of heart failure that has recently gotten worse. They may have had open heart surgery but their heart needed more time to wake up after being on the heart-lung machine in the operating room. They may have had a cardiac arrest and needed CPR. ECMO can help their heart and lungs rest and recover from these incidents.   

Having a loved one on ECMO can feel very chaotic and overwhelming. The medical team will do their best to keep you updated on the plan for your loved one’s care. If you have questions or concerns, please ask your nurse and they will pass these along to your medical team. The medical team will “round” every day your loved one is in the ICU on ECMO.

Often, the first couple of days, the patient will have a breathing tube (be intubated). They will likely be sedated (in a medically-induced coma), though the nurse will wake them up from time to time to monitor their brain function. Then, depending on how they are doing in the next few days, the team may decide to remove the breathing tube and allow the patient to breathe on their own (extubate) while still on ECMO.

For patients who are on ECMO for a prolonged period of time, we aim for more formal family updates every one to two weeks in addition to more frequent updates (usually in person but can have additional family members on zoom if necessary). It is very helpful for us if you can designate one or two family members/friends of the patient to be the primary contacts so we’re not updating multiple family members/friends throughout the day.

ECMO is not a cure. ECMO is a therapy that gives the patient’s heart and/or lungs additional time to rest and recover. The goal is for the patient’s heart and/or lungs to recover on their own, with time on the ECMO machine. Sometimes they don’t recover sufficiently and the patient needs long-term support for their heart and/or lungs. They may require a mechanical heart pump or an organ transplant. 

A large number of people from different specialties are involved in caring for a patient on ECMO. These may include: heart and lung surgeons; ICU doctors, nurse practitioners (NPs), and physician assistants (PAs); ICU nurses; respiratory therapists; ECMO Specialists; physical, occupational, and speech therapists; dieticians; social workers; chaplains; and the palliative care team. 

A number of factors determine whether someone can eat, drink, and talk while on ECMO. Some of these include the type of oxygen therapy the person’s body is requiring, the location of the ECMO cannulas in their body, and the types of medications they are on. If they are unable to eat, a feeding tube will be placed into the stomach through the patient’s nose or mouth which will be hooked up to “tube feeds” to provide nutrition and calories to the patient while they are unable to eat on their own. 

This depends on where the ECMO tubes (cannulas) are in the patient’s body. If they are unable to walk around, the medical team may decide to change their regular ICU bed to a “tilt bed” that allows the patient to stand while staying safely secured to the bed. 

Time spent on ECMO can vary widely, anywhere from a few days to several months, depending on whether it is the heart or lungs that are having problems, on the reason the patient needed to be put on ECMO in the first place, and on how quickly they are recovering.

There are a number of ways the medical team can tell that the patient no longer needs ECMO support. They look at imaging (x-rays, CT scans, and echocardiograms), numbers on the breathing machine, and lab values. Once the team decides the patient is ready, they do a study called a “wean” where they decrease the amount of ECMO support on the machine and monitor how the patient’s body responds. Based on this wean, they will decide whether or not the ECMO support can be removed. 

No. The cannulas are placed under anesthesia. Often times the greatest discomfort is related to lying in bed for a prolonged period of time. The patient’s nurse can give them pain medicine to help if they are uncomfortable. 

As with all medical procedures and therapies, ECMO does come with risks. These include:

• Risk of bleeding
• Risk of stroke or blood clots
• Risk of infection
• Risk of deconditioning/muscle wasting
• Risk of mechanical problems with the ECMO machine

ECMO may not work or may cause serious complications such as kidney failure or a life-threatening infection.

Sometimes ECMO can keep someone alive who would otherwise die without it. The medical team will communicate frequently with you regarding your loved one’s progress to ensure you have an understanding of their condition throughout the course of their illness/recovery.

This will be determined on a case-by-case basis and may vary day-to-day. Sometimes, when someone is very sick and newly placed on ECMO, the medical team will be doing lots of testing, procedures, etc. and it may not be appropriate for family members to stay the night. However, there are times when the patient is stable/expected to be on ECMO for a prolonged period of time and family is welcome to stay over. This is a great thing to discuss with your loved one’s nurse.  

Taking care of yourself is incredibly important. Try to remember to eat and drink, use the bathroom, and get sleep as you can. We encourage you to take some time away from the hospital room to go for a walk, get a coffee, or grab a bite to eat. Your loved one is under a very high level of care while they are in the ICU on ECMO so now is the perfect time to take care of yourself. They will need your support in the coming days once they have been taken off the ECMO machine.

Helpful things for your loved one on ECMO can include playing music for them, bringing in a nice blanket or pillow or other “creature comforts” from home, bringing in books or reading to them, playing card games, playing their favorite shows on TV, etc. Sometimes the best thing to do is simply be a calming, supportive presence. Some families bring in a firestick to plug into the back of the TV which allows their loved one to watch their favorite streaming channels on the hospital TV. 

Coming soon.

Large tubes that go into the biggest veins and arteries (blood vessels) in the body. These allow for the blood to come out of the body, go through the ECMO circuit, and go back into the patient.  

The part of the ECMO circuit where oxygen gets added to the blood and where carbon dioxide is removed. 

The entire ECMO machine including the cannulas, tubing, oxygenator, and pump. 

The amount of blood going outside the patient’s body and through the ECMO circuit every minute. Increasing the flow can mean increasing the amount of ECMO support. Decreasing the flow can mean decreasing the amount of ECMO support.  

A mix of oxygen and air that goes into the blood via a tube attached to the oxygenator. The ECMO Specialist can go up or down on the sweep gas flow rate to decrease or increase the amount of carbon dioxide in the blood. 

Blood thinner medicines that help prevent blood clots 

A special ICU bed that is sometimes used for ECMO patients who we expect to be on ECMO for a longer period of time. It allows the patient to stand upright with their feet on the floor and still be safely secured in bed.  

An imaging study where a doctor or an ultrasound technician looks at the heart function by putting a probe on the patient’s chest. This can tell the healthcare team if the heart has rested and recovered enough to remove the ECMO machine. 

The medical team will put a long probe with a camera down into the patient’s lungs to look at the lung tissue and clean out any mucus or blood in the lungs.  

The process of turning down the support (blood flow) on the ECMO machine to assess for improved heart and/or lung function to help the medical team decide if the patient no longer needs ECMO.  

The process of taking out the cannulas and taking the patient off the ECMO machine. This is a sterile procedure and can be done in the ICU or in the operating room.  

Breathing machine that supports the patient’s breathing and is attached to a tube in the mouth or throat.  

A nurse or respiratory therapist specially trained to take care of the ECMO machine 

Daily huddle with all members of the medical team (surgeon, ICU doctors, nurse practitioners/physician assistants, ICU nurse, ECMO Specialist, respiratory therapist, and pharmacist) outside the patient’s room where the patient’s condition and plan for the day are discussed. Family members are welcome and encouraged to listen. Rounds consist of a lot of medical jargon so the team can explain and translate the conversation afterwards.  

Helps the heart squeeze better and eject blood to the body 

Increases the patient’s blood pressure 

Increases the patient’s blood pressure 

Sedation medicine 

Anti-anxiety and sedation medicine 

Narcotic/opioid pain medicines 

Type of anticoagulation–blood thinner to help prevent blood clots while on ECMO