Extracorporeal Membrane Oxygenation (ECMO)

Procedure

Published Date: 13-07-2024 Updated Date: 12-10-2026

Written by Medicover Team

Medically reviewed by Dr Priyanka Shivajirao Patil, Cardiothoracic & Vascular Surgeon

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ECMO is a form of temporary life support for people whose heart, lungs, or both cannot work well enough during a critical illness. The machine helps add oxygen to the blood and remove carbon dioxide while doctors treat the underlying condition. This support may give the affected organs time to recover, depending on the cause and severity of the illness. ECMO may be used in newborns, children and adults. The type of ECMO selected depends on whether the patient needs heart and circulation support, lung support, or both.

What Is ECMO?

ECMO provides temporary support when severe heart or lung failure prevents the body from receiving enough oxygen or removing carbon dioxide. It does not cure the underlying illness; instead, it supports essential body functions while treatment continues.

ECMO does not directly heal the heart or lungs. It helps maintain oxygen delivery or blood circulation while doctors treat the condition responsible for the patient’s critical illness.

During treatment, blood flows from the patient through special tubes into an external circuit. A component called a membrane oxygenator adds oxygen and removes carbon dioxide. A pump then returns the blood to the body. The way blood enters and leaves the body depends on the type of ECMO being used.

Why Is ECMO Used?

ECMO may be considered for newborns, children and adults with severe heart or lung failure that has not responded adequately to other treatments. It may also be used in selected patients with serious complications following heart transplantation.

ECMO may be considered for serious heart conditions such as:

Severe infection associated with cardiovascular failure
Certain congenital heart defects
Severe hypothermia with serious heart or circulation problems
Myocarditis (inflammation of the heart muscle)
Selected complications following heart surgery or transplantation
Acute myocardial infarction (heart attack) complicated by severe heart failure
Severe heart muscle disease that affects the heart’s pumping ability
Cardiogenic shock, a condition in which the heart cannot pump enough blood to meet the body’s needs

ECMO may also be considered for severe lung and respiratory conditions such as:

Congenital diaphragmatic hernia with severe breathing difficulties
Selected serious pulmonary vascular conditions
Acute respiratory distress syndrome (ARDS)
Meconium aspiration syndrome (MAS) in newborns
Persistent pulmonary hypertension of the newborn (PPHN)
Severe respiratory failure that does not improve with conventional treatment

ECMO is not required for every patient with these conditions. The medical team considers the severity of the illness, the response to other treatments and the possibility of recovery before recommending ECMO.

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How Does an ECMO Machine Work?

The ECMO circuit is connected to the patient through flexible tubes called cannulas. These tubes are placed in suitable large blood vessels, usually in the neck, chest or groin, depending on the patient’s age and treatment needs.
Blood flows through the circuit into a membrane oxygenator, where oxygen is added and carbon dioxide is removed.
A pump moves the treated blood back into the patient’s circulation.
The medical team continuously monitors the patient’s condition and adjusts the circuit settings as required.

What Are the Different Types of ECMO?

ECMO is mainly used in two forms. The choice depends on whether the patient needs support for circulation, breathing, or both.

Veno-Arterial ECMO (VA-ECMO)

Veno-arterial ECMO supports both circulation and oxygen exchange. It is commonly considered when the heart cannot pump enough blood to the body.
Blood is drawn from a large vein, passes through the oxygenator and returns to the body through an artery.
The cannulas may be placed in blood vessels in the neck, chest or groin. The exact placement depends on the patient’s condition and the treatment plan.

VA-ECMO helps maintain blood flow and oxygen delivery when the heart’s pumping function is severely impaired. It may be used in selected cases of cardiogenic shock and other forms of severe cardiac failure.

Veno-Venous ECMO (VV-ECMO)

Veno-venous ECMO primarily supports lung function in patients with severe respiratory failure.
Blood is taken from a large vein, passed through the oxygenator and returned to the venous circulation.
The patient’s heart continues to pump the blood through the body. VV-ECMO supports gas exchange but does not directly replace the heart’s pumping function.
One or two cannulas may be used, depending on the patient’s anatomy and the circuit design.

This type of ECMO may allow the lungs to receive less intensive ventilator support while the underlying respiratory condition is treated.

ECMO Treatment

ECMO treatment requires close monitoring, infection prevention, nutritional support and measures to keep the patient comfortable. The healthcare team also watches for complications and adjusts treatment according to the patient’s response.

Monitoring Patients During ECMO

Patients receiving ECMO are closely monitored for changes in heart rate, blood pressure, oxygen levels and other vital signs.
Blood tests are performed regularly to assess oxygen and carbon dioxide levels, blood counts, clotting and organ function.
The team monitors the blood’s ability to clot rather than simply checking whether it is thin enough. This helps balance the risk of blood clots against the risk of bleeding.
The ECMO circuit is checked regularly to make sure it is working properly and providing the support the patient needs.

Preventing Lung Infections During ECMO

Some patients need a breathing tube called an endotracheal tube (ET tube) to help them breathe.
When secretions collect in the airways, the healthcare team may remove them using a suction device. Learn more about mucus and phlegm.
Suctioning helps clear the airways, but it does not guarantee that a lung infection will be prevented. Infection-prevention measures and regular clinical assessments are also important.

If an infection develops, doctors may perform tests to identify its cause and provide appropriate treatment. Antibiotics are used when a bacterial infection is suspected or confirmed, as clinically indicated.

Supporting Lung Recovery During ECMO

ECMO can take over part of the lungs’ gas-exchange function. This may allow doctors to reduce the strain caused by mechanical ventilation while treating the underlying illness.

ECMO does not directly repair damaged lung tissue. The extent of recovery depends on the cause of respiratory failure, the patient’s overall health and their response to treatment.

Comfort, Medication and Activity During ECMO

Medicines may be given to relieve pain, reduce anxiety and help the patient tolerate treatment.
Some patients require sedation, while others may remain awake and communicate with the healthcare team.
Selected patients may be able to sit up, move or walk with assistance if their condition is stable and the care team considers it safe. This is not appropriate for every patient.

The level of activity depends on the patient’s condition, cannula placement and treatment plan.

Nutrition During ECMO

Adequate nutrition helps support patients during critical illness. The healthcare team decides how to provide nutrition based on the patient’s condition and the function of the digestive system.

Enteral nutrition: Liquid nutrition may be delivered into the stomach or intestine through a feeding tube when the digestive system can be used safely.
Parenteral nutrition: If feeding through the digestive system is not possible or does not meet the patient’s needs, nutrients may be delivered directly into a vein.
Nutritional monitoring: Doctors and dietitians assess energy, protein, fluid, vitamin and electrolyte requirements and adjust the nutrition plan as needed.

Lipids provide fat and energy in some nutritional formulas. Vitamins and electrolytes are supplied according to the patient’s needs.

For further information, see lipid profile testing and vitamin supplements.

What Are the Risks of ECMO?

Although ECMO can provide essential support during critical illness, it has potential complications. The risks vary according to the patient’s condition, the type and duration of ECMO, and other treatments being given.

Bleeding

Blood-thinning medicines, also called anticoagulants, are often used to reduce the risk of clots forming in the ECMO circuit.
These medicines increase the risk of bleeding, which may occur around the cannula insertion sites or inside the body, including the lungs, digestive tract or brain.
The medical team checks blood counts and clotting results and looks for signs of bleeding.
Treatment may involve adjusting anticoagulant medicines, giving blood products or performing a procedure or surgery to control serious bleeding.

Blood Clots (Thromboembolism)

Blood clots may form in the ECMO circuit or in the patient’s blood vessels. If a clot blocks blood flow to an organ, it can cause serious harm.
Air entering the circulation is a separate but also potentially serious complication. The circuit must be checked carefully to reduce this risk.
Heparin is one anticoagulant that may be used to reduce clot formation.
Heparin reduces the risk of clotting but does not eliminate it. It also increases the risk of bleeding, so treatment and monitoring must be carefully managed.

Infection

Infection may develop around the sites where cannulas or other medical tubes enter the body. It can also affect the bloodstream, lungs or other organs.
The healthcare team follows infection-prevention practices and monitors for possible signs of infection.
If an infection is suspected, tests may be performed and appropriate treatment started. Antibiotics treat bacterial infections; they are not effective against viruses.

Stroke

A stroke may occur if a blood clot blocks blood flow to part of the brain or if bleeding develops within the brain.
The effects depend on the area affected and the extent of the injury. Symptoms may include weakness, difficulty speaking, vision changes or problems with memory and movement.
Recovery varies from person to person and may require rehabilitation.

The risk of stroke is not the same for every ECMO patient. It varies according to factors such as the patient’s condition and the type of ECMO being used. Therefore, a statement that stroke occurs in fewer than 5% of all ECMO patients should not be used as a universal figure without a specific, reliable source and a clearly defined patient group.

Conclusion

ECMO is a specialised form of life support that may help patients with severe heart or lung failure when other treatments are not enough. It supports blood circulation or oxygen exchange while doctors treat the underlying illness and assess the patient’s recovery.

ECMO is not a cure, and its benefits and risks differ from patient to patient. Possible complications include bleeding, blood clots, infection and stroke. The treating team can explain why ECMO may be appropriate, what complications need to be monitored and what recovery may involve.

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Frequently Asked Questions

1. What is ECMO?

ECMO (Extracorporeal Membrane Oxygenation) is a life-support machine that takes over the function of the heart and lungs. It oxygenates the blood outside the body, allowing the heart and lungs to rest and heal.

2. Is ECMO done for every heart patient?

No, ECMO is not done for every heart patient. It is typically used for patients with severe heart or lung conditions that do not respond to conventional treatments. ECMO is often considered a last resort.

3. Can the ECMO process cause death?

During the ECMO process, complications such as bleeding, infection, and blood clots can occur. The decision to use ECMO is made based on the potential benefits and risks, and it is usually used in critical situations where the patient's condition is life-threatening.

4. Can children and infants receive ECMO treatment?

Yes, ECMO can be used for children and infants with severe heart or lung conditions. Pediatric ECMO is similar to adult ECMO but requires specialized equipment and expertise.

5. Is ECMO a ventilator?

A ventilator helps patients breathe by pushing air into the lungs, while ECMO oxygenates the blood outside the body and can provide support for both the heart and lungs.

6. Are there any side effects of ECMO?

ECMO can have side effects, including bleeding, blood clots, infections, and complications related to cannulation (insertion of tubes). The medical team takes measures to minimize these risks and manage any complications that arise.