Extracorporeal membrane oxygenation used for virus

Q: My uncle was diagnosed with COVID-19, and his doctors mentioned the possibility of putting him on ECMO. What does this mean?

A: A COVID-19 infection can lead to mild symptoms for many people, but for others, it can cause life-threatening lung failure. In cases like your uncle’s, traditional life support measures, such as a ventilator to support breathing, do not provide enough oxygen to support the body’s vital organs. Extracorporeal membrane oxygenation, or ECMO, also known as extracorporeal life support, or ECLS, is a form of heartlung bypass that is used to provide the body with additional oxygen when other measures have failed. The ECMO device removes blood from the patient’s body, sends it through an artificial lung, and then returns the fully oxygenated blood back to the body.

ECMO is used to help people who are ill with a heart or lung condition. This may include patients with COVID-19, as well as those with pulmonary or cardiac issues.

ECMO may be used with heart conditions such as heart attack, cardiomyopathy, myocarditis, sepsis and cardiogenic shock. In addition to COVID-19, ECMO may be used with lung or pulmonary conditions such as acute respiratory distress syndrome, congenital diaphragmatic hernia, flu, pneumonia, a pulmonary embolism or pulmonary hypertension.

There are two types of ECMO support. Venovenous ECMO is used to support the lungs, and venoarterial ECMO is used to support both the heart and the lungs.

In both types of ECMO, blood is removed from the body through a small tube that is placed into a large blood vessel in the patient’s neck, chest or groin. The blood is sent through an artificial lung in the ECMO machine, which removes carbon dioxide and adds oxygen into the blood. The blood is then rewarmed and sent back into the body through another small tube. This method allows the blood to bypass the heart or lungs. By doing this, your uncle’s body and organs can rest and heal.

ECMO requires the support of a large health care team. It is typically performed at large hospitals that have established programs dedicated to caring for these critically ill patients.

While on ECMO, your uncle will be monitored continuously by his health care team. They will measure his heart rate, blood pressure, oxygen levels, temperature and more. People on ECMO may undergo tests to monitor their condition. They also will have routine blood draws to monitor oxygen and carbon dioxide levels in the blood; blood cells and platelets; and

more. Blood draws also will be used to monitor and adjust the anticoagulation medications used to thin the blood and decrease the risk of blood clots.

People on ECMO receive sedation and pain medications to help make them comfortable. They will be asleep and remain on the ventilator to help them breathe. In some cases, they may be able to wake up and be removed from the ventilator, allowing them to talk and participate in their own care, including physical therapy. Once the patient begins to show signs of recovery, the ECMO device will slowly be turned down to allow the patient’s body to start functioning on its own.

Your uncle will come off ECMO when his lungs have recovered enough to function on their own. The amount of time depends on the specifics of the patient’s condition. — Errin Kalvelage, R.R.T., L.R.T., Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota

DREAMSTIME ECMO is used to help people who are ill with a heart or lung condition.