ECMO works as an artificial lung by delivering oxygen to the patient when the lungs or heart are unable to do so.
With most approaches to ECMO for respiratory failure, a catheter is placed in a central vein, usually near the heart. A mechanical pump pulls blood into the circuit, where the blood passes along a membrane (referred to as an "oxygenator" or "gas exchanger"), providing an interface between the blood and freshly delivered oxygen. Veno-venous ECMO provides respiratory support alone, while veno-arterial ECMO provides both respiratory and cardiac support. Examples of scenarios where ECMO may benefit patients include the following:
- If a patient has life-threatening acute respiratory failure with profound gas exchange abnormalities, ECMO may be used as salvage therapy to rescue the patient.
- ECMO may also be used in patients with ARDS who would benefit from lung-protective ventilation strategies but who are unable to tolerate such strategies.
- ECMO is used in select patients with severe hypercarbic respiratory failure (levels of carbon dioxide in the blood that are too high).
- ECMO may be used in patients with chronic lung disease who are already listed for lung transplantation at NewYork-Presbyterian/Columbia. This approach is called "bridge-to-transplantation."
ECMO can be used as short-term support for cardiac failure. ECMO is a life support system that partially replaces the function of the heart and the lungs. This is a life-saving measure often used in the ER or at the bedside to assist patients who have no blood pressure and failing after a heart attack. Our team has successfully used this technology to help patients recover from acute heart failure/cardiogenic shock.
Some ECMO devices are used as a short-term solution to support the circulation while longer-term options are considered.
Other ECMO devices add oxygen to the blood, remove carbon dioxide, and warm the blood before it is returned to the patient. This technique is most often used in the setting of cardiogenic shock and gives the patient's heart and lungs time to rest and recover.