ECMO, or ExtraCorporeal Membrane Oxygenation, is a machine that is used to support children (and adults in some cases) whose heart and lungs are unable to function at necessary levels.  It is similar to a heart-lung bypass machine, but it outside the body and a membrane oxygenator is used to deliver oxygen to the blood.  It is used on children with very severe lung disease that is not treated with medications/oxygen/ventilator and severe heart failure.  It can only be used in those children whose underlying disease can be reversed within 2 weeks.  There are two types of ECMO: VA (venous arterial which supports heart and lungs) and VV (veno venous which supports only the lungs).  

Procedure Details:

Once the decision is made, the pediatric surgeon in the ICU will place two cannulas (tubes) into the side of the patient's neck, one in the large vein that will go to the right side of the heart and the other in either a large vein (VV) or large artery (VA).  The dark blood with little oxygen drains by gravity into the first cannula and into the ECMO machine and is returned bright red with oxygen into the second cannula.  The ECMO machine consists of a pump ("artificial heart" that pushes blood through ECMO and to body) and an oxygenator ("artificial lungs" that clears the blood of carbon dioxide and allows for uptake of oxygen).  The patient will be a ventilator also.  The ECMO machine works at full capacity initially and then is lowered down as the patient responds appropriately.  

Risks:

• Heparin will be given to prevent clots from the cannula, and this can lead to bleeding problems
• Increased risk of infection
• Risk of bleeding in the brain