What Is ECMO? Know When This Procedure Is Used

The lung damage caused by this inflammation is called Acute Lung injury, which can progress to ARDS - Acute Respiratory Distress Syndrome - where despite maximum oxygen therapy administered through Mechanical Ventilation, fails to deliver the oxygen required by the body. In these situations, ventilator support by itself, is not sufficient to keep up blood oxygen levels since the lungs are severely damaged. This is where ECMO (Extra Corporeal Membrane Oxygenation) comes as a saviour. Simply put, the ECMO machine is similar to the heart-lung by-pass machine used in open-heart surgery. It pumps and oxygenates a patient's blood outside the body, allowing the heart and lungs to rest. When connected to an ECMO, blood flows through tubing to an artificial lung in the machine that adds oxygen and takes out carbon dioxide; then the blood is warmed to body temperature and pumped back into the body. In other words, the ECMO machine replaces the function of the heart and lungs.

What makes ECMO the life saviour during such critical conditions is - irrespective of the degree of ARDS, the patient can be oxygenated by this therapy and kept alive while giving time for lungs to heal and recover. Then the ECMO therapy is slowly weaned off while the lungs take over.

ECMO is commonly used in patients with acute respiratory distress syndrome
Photo Credit: iStock

Having said that, ECMO is not without its own risks. There is a high level of skill set required to access the major blood vessels safely to connect the cannulas to the circuit. This is a challenging task. Having to do this intervention in a remote hospital or a facility which is not geared up for ECMO amplifies the complexities and challenges. Transferring of such a patient on ECMO with its attached circuits and machines (doing the work of the lungs and at times heart as well), even within the hospital is a challenging task. Transferring such patients between multiple vehicles including an aircraft and from one hospital to another is an extremely demanding task and should be undertaken by specially trained set of Doctors, Perfusionists and Paramedics. It should be borne in mind that ECMO does not treat or cure a disease, but can help when the body temporarily can't provide the tissues with enough oxygen.

(Dr. Rahul Singh Sardar and Dr. Shalini Nalwad, MBBS, MRCA, FCAI (UK), Founder & Directors, ICATT - Kyathi Air Ambulance)

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