ECMO
Among the many services provided by the surgeons in this practice, surgical procedures
to care for critical care issues such as Extracorporeal Membrane Oxygenation(ECMO) are
noteworthy. The combined experience of our group reaches 34 years of ECMO related
activities. Two of our group are Fellowship trained, having spent dedicated time in ECMO
related research and patient care. This form of artificial organ support for children
suffering from temporary, reversible lung failure or heart failure has been in use at
Egleston for almost 9 full years. This temporary artificial organ support allows the lungs
to be rested when injured and avoids the harmful effects of aggressive mechanical
ventilation (Veno-Venous or VV bypass). It can also be used to provide cardiac support
when the heart is stunned after cardiopulmonary bypass surgery (Veno-Arterial or VA
bypass). This procedure can be used to treat patients with pulmonary insufficiency from
surgical problems such as congenital diaphragmatic hernia or trauma, as well as several
medical problems that are complicated by lung failure.
During the ECMO procedure, catheters are placed in large blood vessels and used to
simultaneously drain blood from the body, oxygenate and warm it, and then return it to the
heart through another cannula. The patient is heavily sedated during the ECMO course until
the lungs have recovered and the cannulas are then removed through a second operative
procedure. Historically, this procedure has been performed in an "open" fashion,
through an incision in the neck or groin. More recently, we have begun using the
"closed" or percutaneous method of placing the catheters into the vessels using
a guidewire technique, thus decreasing the time to initiate supportive bypass in these
critically ill patients, as well as minimizing the blood loss that occurs when such as
procedure is done. ECMO has significantly reduced the mortality rate for acute respiratory
failure and provides an important compliment to the critical care services at Egleston.
