Extracorporeal Membrane Oxygenation (ECMO)

2025/06/04

What is ECMO?

Extracorporeal Membrane Oxygenation (ECMO), also known as Extracorporeal Life Support (ECLS), is an artificial heart and/or lung machine which supports the body when a person’s heart and/or lungs are too sick to carry out their normal function.

ECMO does not treat the disease but allows the heart and/or lungs to rest and recover, and for the necessary treatments and investigations to be carried out.

ECMO may be necessary when the team has exhausted all other medical treatment options.

How does ECMO work?

ECMO continuously pumps blood out of the body and passes it through an artificial lung (also known as an oxygenator), which provides oxygen and removes carbon dioxide. This oxygenated blood is then pumped back into the body.

Common medical conditions that may require ECMO

Severe pneumonia (lung infection)
Myocarditis (inflammation of the heart muscle)
After heart surgery
Cardiac arrest
Heart attack

What are the different types of ECMO?

1. VenoVenous (VV) ECMO

This type of ECMO is used to provide support for a patient whose lungs have failed. Blood is taken from a vein through a cannula (tube) in the groin and returned to another vein in the neck/groin.

2. VenoArterial (VA) ECMO

This type of ECMO is used to provide support for a patient whose heart is failing. Blood is withdrawn from a vein via a cannula in the groin or neck and returned to an artery (a blood vessel that carries oxygenated blood away from the heart) via a cannula, usually at the top of the leg.

Who is involved in the care of an ECMO patient?

The patient will be taken care of in the Cardiothoracic Intensive Care Unit (CTICU) by a core team of specialized doctors, nurses, perfusionists, pharmacists, medical social workers, respiratory therapists and physiotherapists.

How long does a patient need ECMO?

VV ECMO support can range from weeks to months.

VA ECMO support generally does not go beyond 7-10 days.

What to expect when a patient is on ECMO?

1. Consciousness

Patients are generally sedated. Painkillers and light sedatives are given to help them rest and feel comfortable. In selected patients, they may be kept off sedation and be awake.

2. Breathing

Most patients will need a breathing tube, which is connected to a ventilator (breathing machine), and they will be sedated for comfort.

3. Circulation

Patients will have a plastic tube (central line) inserted into a major vein in the neck or groin to receive medications, such as those required to support the blood pressure.

4. Pain

Most patients will be given a continuous infusion of painkillers to ensure comfort. The patient’s response to treatment is monitored and additional painkillers are given when necessary.

5. Nutrition

At the appropriate time, milk feeding will be commenced through a tube in the stomach that is inserted through the nose.

6. Excretion

A urine catheter will be inserted to continuously drain urine. Those with kidney failure will need temporary dialysis until their kidneys recover.

7. Exercise

Early exercise can prevent or slow down muscle wasting that can occur with bedrest during ECMO. The patient may undergo neuromuscular electrical stimulation for muscle preservation during bedrestand, in some instances, may be mobilized out of bed when awake to prevent weakness and promote early functional independence.

8. Routine Investigations Performed

Blood tests: To monitor organ function and levels of blood clotting activity while the patient is on blood thinners.
Echocardiography: Ultrasound of the heart to monitor heart function.
Bronchoscopy: A scope is inserted into the airway and lungs, to inspect and remove secretions.
Radiological scans: CT scans and X-rays.

9. Weaning

When suitable, the Cardiothoracic ICU team will conduct an ECMO removal test to assess if the patient is ready to come off ECMO. This requires the patient to remain stable while progressively reducing ECMO support.

Potential risks and complications

Infections.
Blood clotting complications such as stroke.
Bleeding from any surgical cuts, around the ECMO cannulas, from the mouth or nose, or bleeding into other parts of the body such as the brain.
Loss of blood flow to the limbs.
Equipment malfunction (<0.5% chance). A spare pump is kept at the patient's bedside at all times as a safety measure, in the rare case where the equipment fails.

The potential risks are balanced with the often critical consequences of not providing ECMO. Generally, the complications faced are due to the underlying illness and not the ECMO machine itself.

What happens after a patient comes off ECMO?

The patient will be monitored closely to ensure that they remain stable. Rarely, patients may be required to go back on ECMO.

If a patient remains off ECMO for a few days but still requires intensive care treatment, he or she may be transferred to another ICU to continue treatment for their respective conditions. Some patients remain well enough to be transferred to the general ward.

Who can I reach out to for help or support for a patient on ECMO?

1. Patient Progress Updates

Cardiothoracic ICU doctors can provide you with daily medical treatment updates. You can also approach our bedside nurses for more information about the patient’s daily progress.

When necessary, a family conference will be arranged to address any concerns.

2. Emotional Support

If you are finding it difficult to cope with the situation, our Medical Social Workers can be contacted to assist you.

3. Treatment Course

You can approach the Patient Service Center (PSC) for assistance with financial counselling, and if appropriate, you will be referred for financial assistance.

4. Other Resources

The Extracorporeal Life Support Organization (ELSO) is the world’s largest medical society committed to ECMO. Details can be found at www.elso.org.