ECMO

What is ECMO?

ECMO (extracorporeal membrane oxygenation) is a type of artificial life support. It can help you when your lungs and heart aren’t functioning correctly. An ECMO machine constantly pumps blood out of your body and then sends it through devices that add oxygen and remove carbon dioxide. It then pumps the blood back into your body.

ECMO stands for extracorporeal membrane oxygenation. Extracorporeal means “outside the body.” The rest of the name refers to getting oxygen to your body’s cells.

An ECMO procedure helps people who need support for their lungs or heart. But it can also bypass both organs. ECMO can make it possible for your heart and lungs to rest and heal from a respiratory infection, heart attack or trauma.

Healthcare providers consider ECMO a type of life support for people who need intensive or critical care. A ventilator is a type of life support, but it can only move air. It can’t add oxygen to and remove carbon dioxide directly from your blood. ECMO can exchange these gases like your lungs do.

Types of ECMO

Types of extracorporeal membrane oxygenation include:

• VA ECMO: The venoarterial type supports both heart and lung function. It bypasses your lungs and heart.
• VV ECMO: The venovenous type only supports your lungs’ function. But your heart may work better because it’s getting more oxygen.

What conditions does this machine treat?

Healthcare providers use an ECMO procedure for:

• Acute respiratory distress syndrome (ARDS): Damage to your lungs can cause this, limiting how well your lungs can put oxygen in and take carbon dioxide out of your blood. This can happen because of respiratory infections, burns, drowning or other causes.
• Pulmonary embolism: This happens when a blood clot that formed somewhere in your body (usually your legs) travels to your lungs and gets stuck. This can keep blood from flowing through your lungs, which can be deadly.
• Heart injuries: You may need ECMO if you have damage to your heart muscle from trauma, or from other diseases or conditions. Some of these include a heart attack, a fall or a car crash.
• Infants and newborns: Babies (especially if preterm) with heart and lung problems often receive ECMO.
• Transplants and surgeries: Providers use ECMO for someone waiting for a heart or lung transplant. They may also use it for transplant, heart or lung surgery or recovery after surgery. It can also keep an organ donor alive.

How commonly is an ECMO machine used?

Providers used ECMO more than 21,000 times worldwide in 2024, according to the Extracorporeal Life Support Organization. About 600 hospitals worldwide can provide ECMO.

ECMO has helped many people in critical care units (CCUs) and intensive care units (ICUs) for decades. It’s also getting more use as an add-on to CPR. And critically ill people with COVID-19 have received this treatment.

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, legs 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. During extracorporeal membrane oxygenation, you may be awake or sedated.

An ECMO specialist will routinely check your heart and lung functions while you’re on ECMO to make sure you’re in good condition and there are no 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 this treatment?

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 potential benefits and risks of ECMO?

An ECMO machine can be a lifesaving tool for people who are critically ill. It can support their lungs and heart, which can:

• Ease the strain on your heart and lungs, making it possible for these organs to heal
• Keep you alive during surgery or another medical procedure
• Support you as you wait for a transplant
• Help infants who were born with heart issues or lungs that weren’t fully developed

While an ECMO machine is a vital medical tool, it’s also one that has risks. Some of them are significant. The risks of extracorporeal membrane oxygenation include:

• Clotting problems: Anyone on ECMO also has to be on blood thinners because of the risk of clots forming. Clots could also become stuck in the ECMO circuit, interrupting blood flow.
• Infection: Any break in your skin poses a risk for infection, and the tubes of an ECMO circuit can give an infection direct access to your bloodstream. This can make it easier for an infection to spread throughout your 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 range is slightly lower than normal blood oxygen levels. Maintaining an even blood oxygen level throughout your body can also be a challenge.
• 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: Stroke can occur as a result of either sudden bleeding in the brain during ECMO support or from clots in the circuit that end up traveling to the brain. This can be life-threatening.

What are the long-term effects?

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 fix this or remove part of your leg.

Is there anything a family can do to make this treatment easier on a loved one?

You can help a loved one 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 survival rate on ECMO?

The survival rate varies widely depending on the reason a healthcare provider uses ECMO. For example, anywhere from 4 to 8 out of 10 neonates may survive ECMO. Survival rates for babies with heart failure may be lower than for those with lung issues.

Researchers studying life expectancy after ECMO found that about 3 out of 10 adults lived five years after ECMO. Nearly 8 out of 10 people who survived the first 30 days lived another five years.

Is ECMO a last resort?

Healthcare providers use ECMO for people who have severe heart or lung problems when other treatments have failed. They use this treatment for conditions that can get better. But you can still die while on ECMO if providers can’t fix the condition you have.

When should an ECMO machine not be used?

There are several conditions or circumstances where ECMO isn’t an option. These include:

• 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
• Your size prevents safe access to your blood vessels