Extracorporeal Membrane Oxygenation (ECMO)

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.


ECMO: Advanced Cardiopulmonary Support

 
ECMO Services We Offer

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.

A child’s condition may call for one of two different ECMO treatments:
  1. Venovenous (VV) ECMO is used when the heart is working but the lungs need time to rest and heal. VV ECMO supports the lungs by providing gas exchange, but does not directly support the circulatory system or heart with pumping force.
  2. Venoarterial (VA) ECMO is used when both the heart and the lungs need time to rest and heal. VA ECMO supports the lungs by providing gas exchange, and directly supports cardiac function.
 
ECMO Team Members

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.

Team members may include:
  • cardiac anesthesiologist — a doctor with special training and experience in providing anesthesia and/or sedation, supporting vital functions and pain management
  • attending physician/surgeon — the doctor in charge of your child’s care
  • ECMO coordinator — the manager of the ECMO department who acts as an extra resource for the care team and is responsible for organizing the equipment and training the people required to perform ECMO
  • ECMO physician — a doctor who specializes in ECMO treatment
  • perfusionist — a specialist with advanced training in both heart-lung machines and ECMO
  • respiratory therapist — a specialist in ventilators (breathing machines) and lung care
  • ECMO specialist — a nurse, respiratory therapist or perfusionist who is specially trained to monitor the ECMO circuit
  • nurse — a pediatric nurse who cares for your child in the hospital
  • nurse practitioner — a nurse with advanced training and education who provides care under the guidance of the attending physician/surgeon
  • social worker — a professional who helps families deal with the experience of having a child in the hospital
 
What to Expect if Your Child Receives ECMO

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.

 
Conditions That May Require ECMO

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.

The most common conditions that may lead to the need for ECMO treatment include:
  • acute respiratory distress syndrome (ARDS, a life-threatening lung condition that prevents adequate oxygenation of blood circulating through the lungs)
  • cardiac arrest (a sudden stop in effective blood circulation due to the failure of the heart to contract)
  • cardiomyopathy (heart muscle malfunction for genetic or other reasons)
  • congenital diaphragmatic hernia (when part of the stomach bulges through the diaphragm, which is an important breathing muscle
  • congenital heart disease (a heart defect present at birth), including:
  • hypoplastic left heart syndrome (HLHS)
  • tetraology of Fallot (TOF)
  • transpositon of the great arteries (TGA)
  • failure to wean from cardiopulmonary bypass
  • low cardiac output syndrome (LCOS; a decrease in heart output that causes an inadequate supply of oxygen for the body)
  • meconium aspiration syndrome (MAS; can develop when, either before or during birth, a baby inhales meconium, the dark green waste produced in the baby’s gut while still in the uterus)
  • myocarditis (infection of the heart muscle)
  • neonatal sepsis (a bacterial bloodstream infection in a newborn)
  • persistent pulmonary hypertension (high blood pressure in the arteries that feed the lungs)
  • pneumonia (infection of the lungs)
  • severe asthma in infants

ECMO Referrals for Physicians and Hospitals

Direct Admit or Transport to Nemours Children's Hospital in Orlando

  • (855) KID-ADMIT (543-2364) for transfers/acceptance and to request transport
  • (407) 567-4245 for NCH Emergency Department direct line

Nemours Cardiac Center, Orlando
Nemours Children’s Hospital
13535 Nemours Parkway, Orlando, FL 32827
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