ECMO

ECMO (extracorporeal membrane oxygenation) is a type of artificial life support that can help you when your lungs and heart aren’t working as they should. Extracorporeal means “outside the body.”

An ECMO machine constantly pumps blood out of your body and sends it through devices that add oxygen and remove carbon dioxide. The machine then pumps the blood back into your body. This eases the strain on your heart and lungs, making it possible for these organs to heal.

There are two main types of ECMO:

• VA-ECMO (veno-arterial): This type supports both heart and lung function. It bypasses your lungs and heart.
• VV-ECMO (veno-venous): This type only supports your lung function. But your heart may work better because it’s getting more oxygen.

Healthcare providers may use ECMO to help manage:

• Acute respiratory distress syndrome: This is a life-threatening lung injury with a wide range of causes, including sepsis, COVID-19, major trauma, burns and drug overdose.
• Pulmonary embolism: This happens when a blood clot that formed somewhere in your body (usually your legs) travels to your lungs and blocks blood flow.
• Heart injuries: You may need ECMO if you have damage to your heart muscle from a heart attack, trauma or other causes.
• Transplants and surgeries: ECMO may support you as you wait for a heart or lung transplant. Providers may also use it during heart or lung surgery or recovery.

ECMO can be lifesaving, and it’s been used for decades. Globally, providers used it more than 23,000 times in 2024. Aside from helping critically ill adults, it can also help infants who are born with heart issues or lungs that aren’t fully developed.

What happens during an ECMO procedure?

During ECMO, blood flows out of your body through a tube in a large blood vessel in your chest, leg or neck. A pump pushes your blood through tubes that carry it to a machine that adds oxygen and removes carbon dioxide. Then, the ECMO machine pumps your blood back into your body.

A healthcare provider may refer to the process of placing these tubes as ECMO cannulation. You’ll be sedated, so you won’t feel the tubes going in. As you stay on ECMO, you may be awake or sedated.

An ECMO specialist will routinely check your heart and lung functions to make sure you’re in good condition and that there aren’t any complications. This also lets providers know how much longer to keep you on ECMO.

Once you show signs of recovery, providers will begin weaning you off ECMO. In most cases, this process takes between two and five days. Then, a provider will remove the tubes and stitch the skin where the tubes were.

How long will I need ECMO?

The length of time you spend on ECMO depends on why you need it. People can stay on extracorporeal membrane oxygenation anywhere from hours to days to weeks. The ECMO machine gives your lungs (and sometimes your heart, too) a chance to rest and recover. Meanwhile, healthcare providers treat the conditions you have.

What are the risks?

While an ECMO machine is a vital medical tool, it’s also one that has risks, including:

• Clotting problems: Anyone on ECMO must also be on blood thinners because of the risk of clots forming. Clots could also become stuck in the ECMO circuit and disrupt blood flow.
• Infection: Any break in your skin poses a risk for infection. The tubes of an ECMO circuit can cause an infection to enter your bloodstream and spread to your whole body.
• Bleeding: Because tubes have to go into major arteries and veins, this can increase your risk of bleeding. Blood thinners also increase the risk of bleeding.
• Low or uneven blood oxygen levels: In general, ECMO’s target blood oxygen range is slightly lower than normal. It can also be hard to keep an even level throughout your body.
• ECMO circuit failure: A mechanical failure in any part of the ECMO circuit can cause the entire circuit to stop. This can be life-threatening.
• Stroke: A life-threatening stroke can result from bleeding in your brain or clots in the circuit that travel to your brain.

Are there any long-term effects of ECMO?

If your kidneys don’t get enough blood flow during ECMO, they can fail (stop working). A dialysis machine can take over your kidneys’ job for the short term. But you may need dialysis for the rest of your life.

If you don’t have good blood flow to the leg where the ECMO machine connects, leg tissue can suffer. In rare cases, you may need surgery to repair damage or remove part of your leg.

How can I help a loved one who’s on ECMO?

You can help by providing simple comforts. Just check with a provider to be sure it’s OK. You may:

• Talk or read to them.
• Sing or play music.
• Bring family photos for them to see.
• Put lotion on their skin.

What is the life expectancy after ECMO?

It varies widely according to the reason you’re on ECMO. Researchers found that about 3 out of 10 adults lived five years after ECMO. About 7 out of 10 people who survived the first 30 days lived another five years.

Can a person die while on ECMO?

Yes, you can die while on ECMO if healthcare providers can’t fix the condition you have. Providers use ECMO for people who have severe heart or lung problems when other treatments have failed, but there’s still a chance of recovery.

What’s the difference between ECMO and a ventilator?

ECMO and a ventilator are both types of life support. But a ventilator can only move air. It can’t add oxygen to and remove carbon dioxide directly from your blood. ECMO can exchange these gases, as your lungs do.

When should an ECMO machine not be used?

ECMO isn’t an option when you have:

• Heart, lung or circulatory problems that aren’t repairable or that a transplant won’t fix
• Damage to other critical organs, like your liver or brain
• Cancer that has spread from where it started
• Uncontrolled internal bleeding (especially in your head) or injuries that could lead to uncontrolled bleeding
• Blood vessels that a healthcare provider can’t safely access