My first experience with extracorporeal membrane oxygenation (ECMO) occurred when I was a new nurse in the intensive care unit. ECMO therapy was being utilized as a bridge to left ventricular assist device (LVAD) placement for a patient in cardiopulmonary shock following open-heart surgery. This large academic hospital had the essential mix of clinical expertise and resources to employ the latest life-saving technologies.
To say I was in awe is an understatement. I knew patients were commonly placed on bypass for surgery, however implementing this high-risk machinery at the bedside for days, and sometimes weeks, was simultaneously fascinating and frightening. Even as I gained experience, it was always extremely stressful to care for patients on ECMO. Twenty years later, while ECMO remains a highly specialized therapy, more hospitals are adopting this temporary form of life support.
What exactly is ECMO? (Bartlett, 2020; Calhoun, 2018)
ECMO is used for both cardiac and pulmonary failure when conventional measures are no longer effective to support life. Rather than providing a cure for the underlying disease process, ECMO delivers oxygen-rich blood to vital organs, which gives the heart and lungs time to repair. During ECMO, blood is drained from the patient’s vascular system and then circulated outside the body by a mechanical pump through an oxygenator and heat exchanger. Carbon dioxide (CO2
) is removed and oxygen-saturated blood is returned to the body.
The one major contraindication for ECMO is a pre-existing condition that would prevent recovery, such as severe neurological injury or end stage cancer. Relative contraindications include uncontrolled bleeding and poor prognosis from a primary diagnosis. For patients with severe acute respiratory failure, research has shown that ECMO should be used early in the course of a patient’s illness (within the first seven days) rather than employing it as a rescue therapy.
Patients on ECMO are among the sickest of the sick. The patient’s room will be full of an array of highly trained staff and advanced life support technologies: the ECMO machine, a ventilator, continuous dialysis, infusion pumps, etc. This technology may be very intimidating, but it gets easier as you gain more experience managing patients on these life-support devices. Caring for ECMO patients is mentally and physically challenging, requiring nuanced monitoring as well as family support and education. Yet these challenges are offset by the rewards of caring for ECMO patients. ECMO nurses are in high demand and never stop learning. There is tremendous satisfaction in witnessing patients recover from such devastating illness.
To learn more, check out the additional reading and resources below as well as the guidelines
provided by the Extracorporeal Life Support Organization
Bartlett, R. (2020). Extracorporeal membrane oxygenation (ECMO) in adults. UpToDate.
Calhoun A. (2018). ECMO: Nursing Care of Adult Patients on ECMO. Critical care nursing quarterly, 41(4), 394–398. https://doi.org/10.1097/CNQ.0000000000000226
Naddour, M., Kalani, M., Ashraf, O., Patel, K., Bajwa, O., & Cheema, T. (2019). Extracorporeal Membrane Oxygenation in ARDS. Critical care nursing quarterly, 42(4), 400–410. https://doi.org/10.1097/CNQ.0000000000000280