VA-ECMO

VA-ECMO (veno-arterial extracorporeal membrane oxygenation) is a type of temporary life support that takes over the work of your heart and lungs. Healthcare providers connect you to a machine that adds oxygen to your blood and removes carbon dioxide. The machine then sends the blood back into your body, where it flows to your organs and tissues, keeping you alive.

On its own, VA-ECMO isn’t a treatment. But it can serve as a “bridge” until you receive treatment for:

• Cardiogenic shock: Your body suddenly can’t pump enough blood to nourish your organs. It can happen for a lot of reasons, including a heart attack, a pulmonary embolism or end-stage cardiomyopathy.
• Primary graft dysfunction after a heart transplant: The donor heart can’t pump enough blood to meet your body’s needs immediately after the transplant surgery.
• Cardiac arrest: Your heart suddenly stops beating. Rarely, providers use VA-ECMO if CPR can’t restart your heart quickly enough. This is sometimes called E-CPR.

VA-ECMO isn’t common. Providers only use it when your chance of recovery is good enough that the risks are worth it. Possible complications of VA-ECMO include:

• Bleeding
• Blood clots
• Brain damage
• Fluid buildup in your lungs (pulmonary edema)
• Infection
• Kidney damage

Hospitals that offer ECMO have dedicated teams that assess each person’s case and decide if it’s an option for them.

How does VA-ECMO work?

To understand how VA-ECMO works, it helps to know what each part of the name means:

• Veno-arterial: This term describes the configuration of an ECMO circuit. A veno-arterial circuit acts like your heart. It drains blood from your veins, sends it to the machine’s artificial lung for oxygenation and then returns it to your arteries. The arteries, in turn, deliver that oxygen-rich blood to your body and vital organs to keep you alive.
• Extracorporeal: This means outside your body.
• Membrane: This refers to the part of the ECMO machine that acts as the artificial lung. The machine circulates your oxygen-poor blood through the membrane to fill it up with oxygen, before returning it to your body to nourish your vital organs
• Oxygenation: This is the process by which oxygen is added to your blood by the machine’s artificial lung before the machine’s artificial heart pumps the oxygen-rich blood back to your body.

VA-ECMO provides both cardiac (heart) and respiratory (lung) support. The machine takes on the burden of your native heart and lungs, allowing them to rest and recover.

A team of highly trained healthcare professionals initiates and manages VA-ECMO. These teams typically include physicians, surgeons, nurses, respiratory therapists and other specialists.

What happens during this treatment?

Your care team connects you to an ECMO machine, which stays right next to your bed. You can think of the machine like an extension of your body. Tubes connect your body to the machine. Your team will also connect you to other monitors that track your vital signs and show how your body is responding to treatment.

These are the basic steps for VA-ECMO:

1. Sedation and anesthesia: You’ll receive medication to put you to sleep and keep you from feeling pain while providers connect you to the ECMO machine.
2. Venous cannulation: Your care team will place a strong tube called a cannula into a vein in your chest or groin. Common sites are the internal jugular vein or the femoral vein. These veins send oxygen-poor blood into the machine.
3. Arterial cannulation: Your care team will place another tube into an artery in your chest or groin. This tube carries oxygen-rich blood back into your body. The blood can then circulate to your organs and tissues.
4. Anticoagulation: When blood flows through a device with artificial parts, it’s more likely to clot. That’s why you’ll receive medicine (heparin) that lowers the risk of clots forming.
5. Monitoring: Your care team will keep a close eye on your blood pressure, blood oxygen levels, heart function and more. This helps them know if enough oxygen is reaching your organs and tissues. They’ll also evaluate how well your heart is recovering.
6. Waking up: If possible, your care team will wake you up from the sedation once everything is all set up. This allows them to assess your speech and other signs of brain function. You’ll still receive medication to relieve pain and keep you as comfortable as possible.

How long will I need VA-ECMO?

You can typically stay on VA-ECMO for up to five to seven days. Meanwhile, you’ll receive medications to support your heart function. Your care team may begin weaning you off the machine when your heart and lungs are strong enough to take over again. Weaning means they gradually reduce blood flow from the machine. Your heart and lungs slowly return to their normal duties.

If weaning doesn’t go well, your care team will discuss possible next steps with you and/or your loved ones. These include:

• Left ventricular assist device (LVAD): A surgeon implants this device in your chest. It helps your heart pump better.
• Heart transplant: A surgeon replaces your heart with a donor heart.
• Palliative care: In cases where an LVAD or a transplant isn’t possible, providers may recommend symptom relief and comfort care.

What is the outlook for a person on VA-ECMO?

It depends on the severity of the underlying condition and any organ damage that’s already occurred. Your care team will explain what to expect in your case.

Some research shows that about 4 in 10 people who receive VA-ECMO for cardiogenic shock survive and leave the hospital. Long-term survival and quality of life can vary widely.

Because VA-ECMO helps people who are already very ill, it’s hard to know what might happen. Care teams understand this difficult reality. They’ll do everything possible to support you and your loved ones.