Basics of Extracorporeal Membrane Oxygenation (ECMO)

My first experience with extracorporeal membrane oxygenation (ECMO) was after I was a brand new nurse within the intensive care unit. ECMO therapy was used as a bridge to placement of a left ventricular assist device (LVAD) in a patient with cardiopulmonary shock following open heart surgery. This large academic hospital had the crucial combination of clinical expertise and resources to utilize the most recent lifesaving technologies.

To say I used to be impressed is an understatement. I knew that patients were often placed on bypass for surgery, but having this high-risk machine at my bedside for days, sometimes weeks, was each fascinating and terrifying. Even after gaining experience, caring for patients on ECMO was all the time incredibly stressful. Twenty years later, although ECMO stays a highly specialized therapy, an increasing number of hospitals are adopting this temporary type of life support.

What exactly is ECMO? (Bartlett, 2020; Calhoun, 2018)

ECMO is used for each heart and lung failure when conventional methods aren’t any longer effective in sustaining life. Rather than providing a cure for the underlying disease process, ECMO delivers oxygen-rich blood to vital organs, giving the guts and lungs time to recuperate. During ECMO, blood is drained from the patient’s vascular system after which distributed outside the body using a mechanical pump through an oxygenator and a heat exchanger. Carbon dioxide (CO₂) is removed and the oxygenated blood returns to the body.

The only major contraindication to ECMO is a pre-existing condition that forestalls recovery, resembling severe neurological damage or end-stage cancer. Relative contraindications include uncontrolled bleeding and a poor prognosis based on the initial diagnosis. Studies have shown that in patients with severe acute respiratory failure, ECMO needs to be used early in the midst of the disease (throughout the first seven days) and never as an emergency therapy.

ECMO patients are among the many sickest. The patient room can be stuffed with highly trained staff and advanced life support technology: ECMO machine, ventilator, continuous dialysis, infusion pumps, etc. This technology may be very intimidating, however it becomes easier as you gain experience managing patients on these life support devices. Caring for ECMO patients is a mental and physical challenge, requiring nuanced monitoring, in addition to family support and education. However, these challenges are offset by the advantages of caring for ECMO patients. ECMO nurses are in high demand and never stop learning. It is incredibly rewarding to observe patients recuperate from such a devastating disease.

To learn more, please review the extra reading and resources below, in addition to guidelines delivered by Organization of extracorporeal life support.

Bartlett, R. (2020). Extracorporeal membrane oxygenation (ECMO) in adults. .
https://www.uptodate.com/contents/extracorporeal-membrane-oxygenation-ecmo-in-adults

Calhoun A. (2018). ECMO: Nursing take care of adult patients on ECMO. , (4), 394–398. https://doi.org/10.1097/CNQ.0000000000000226

Naddour, M., Kalani, M., Ashraf, O., Patel, K., Bajwa, O., and Cheema, T. (2019). Extracorporeal membrane oxygenation in ARDS. , (4), 400–410. https://doi.org/10.1097/CNQ.0000000000000280