Extracorporeal membrane oxygenation
ECMO; Heart-lung bypass - infants; Bypass - infants
Extracorporeal membrane oxygenation (ECMO) is a treatment that uses a pump to circulate blood through an artificial lung back into the bloodstream of a very ill baby. This system provides heart-lung bypass support outside of the baby's body. It may help support a very ill child who is awaiting a heart or lung transplant.
WHY IS ECMO USED?
ECMO is used in infants who are extremely ill due to breathing or heart problems. The purpose of ECMO is to provide enough oxygen to the baby while allowing time for the lungs and heart to rest or heal.
The most common conditions that may require ECMO are:
- Congenital diaphragmatic hernia (CDH)
- Heart malformations
- Meconium aspiration syndrome (MAS)
- Severe pneumonia
- Severe air leak problems
- Severe pulmonary hypertension
It may also be used during the recovery period after heart surgery.
HOW IS A BABY PLACED ON ECMO?
Starting ECMO requires a large team of caregivers to stabilize the baby, as well as the careful set-up and priming of the ECMO pump with fluid and blood. Surgery is performed to attach the ECMO pump to the baby through catheters that are placed into large blood vessels in the baby's neck or groin.
WHAT ARE THE RISKS OF ECMO?
Because babies who are considered for ECMO are very ill, they are already at high risk for long-term problems, including death. Once the baby is placed on ECMO, additional risks include:
- Blood clot formation
- Transfusion problems
Rarely, the pump can have mechanical problems (tube breaks, pump stops), which can harm the baby.
However, most babies who need ECMO would probably die if it were not used.
Carlo WA. Respiratory Tract Disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 95.
Jobe AH. The respiratory system. In: Martin R, Fanaroff A, Walsh M, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 8th ed. Philadelphia, PA: Mosby Elsevier; 2006:chap 42.
Roosevelt GE. Acute Inflammatory Upper Airway Obstruction (Croup, Epiglottitis , Laryngitis, and Bacterial Tracheitis). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 377.