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Nemours Cardiac Center, Orlando located at Nemours Children’s Hospital offers ECMO (extracorporeal membrane oxygenation), a specialized cardiac and respiratory support system. We provide ECMO support to newborns, older infants, children and teens in need of cardiopulmonary support.
ECMO can give the lungs and heart time to rest and heal. “Extracorporeal” means support that takes place outside the body. “Membrane” refers to the type of artificial lung that’s used. “Oxygenation” means supplying oxygen to the blood.
The ECMO machine is sometimes referred to as “the circuit” because the circulation of blood from the patient to the machine and back forms a loop. The machine’s pump moves blood from a child to the machine and back to the child through sterile plastic tubes. The ECMO membrane adds oxygen to the blood and removes carbon dioxide, just as functioning lungs would. Carbon dioxide is a waste gas that is usually removed from the blood by breathing.
At Nemours Children’s Hospital, a team of physicians, nurses, respiratory therapists and other specialists will care for your child. As the first step in starting ECMO, a care team member will review the risks and benefits of starting ECMO with you. If you consent to initiate ECMO, a surgeon will proceed with the ECMO setup by inserting the tubes (a surgeon will also remove the tubes when treatment is finished).
Members of the ECMO team will visit you in your child’s room each morning to discuss a plan of care for that day.
To provide a direct line to your child’s heart, one or more plastic tubes called “cannulas” are surgically placed into large blood vessels of your child’s body, most often in the neck, leg or chest. The tubes drain blood from the heart into the ECMO circuit. As the blood is pumped through the circuit, oxygen is added and then the blood flows back into your child’s body. With the machine helping, the lungs and/or heart have a chance to recover.
Even though the ECMO machine is doing most of the work for the lungs, your child will also use a breathing machine called a “ventilator.” The ventilator works through a tube in the nose or mouth that sends just the right amount of air pressure in and out of the lungs. The moving air helps your child’s lungs stay slightly expanded.
Many children become very swollen during their first few days on ECMO. The swelling, known as “edema,” may be unsettling to see, but the care team is familiar with this side effect and will make sure the ECMO machine is working properly. Usually, much of the edema disappears by the end of ECMO treatment.
In most cases, children are sedated (asleep) while on ECMO. Those who are awake are protected from pain or discomfort with pain medication given through an IV (a small tube inserted in a vein) or directly into the ECMO machine. We can give extra doses of pain medication if your child seems uncomfortable.
ECMO is a treatment for serious problems of the heart or lungs (or both). It’s used when a patient’s heart or lungs are too sick to continue supporting the patient’s life and all other treatments that could help them work better have been tried.