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What is ECMO?


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Our body needs oxygen all the time. The absence of oxygen can lead to death in just a few minutes. Most of us know how blood flows in the body. The blood has to go through the heart and lungs so it can provide the oxygen needed by the our cells. Ever wonder how doctors keep a human body alive while performing a full heart or lung transplant?

The solution is ECMO which stands for extracorporeal membrane oxygenation. ECMO is a type of life support that serves as a substitute for the functions of heart and lungs. ECMO can provide the necessary oxygenation of the body while doctors perform a surgery such as heart or lung transplant to cure an underlying disease or to put those organs at rest so it can heal and recover. ECMO also serves as a bridge option to further treatment when doctors want to assess the state of the other organs such as the kidneys or the brain before performing a heart or lung surgery. The three main parts of ECMO are the pump, membrane oxygenator, and the warmer/filter device. The pump serves as an artificial heart, the membrane oxygenator serves as an artificial lung, and the warmer/filter device warms and filters the blood before returning back to the body.

Robert Bartlett from the University of Michigan and his colleagues developed ECMO during the 1960s and 1970s through laboratory research. Barlett graduated from Albion College and the University of Michigan Medical School as a general surgeon and a thoracic surgeon. Although extra-corporeal oxygenation exists since the late 1800, it was only the time during Bartlett when ECMO became successful to infants. Baby Esperanza was the first neonatal patient to survive with the use of ECMO according to Bartlett. The application of ECMO to Esperanza was the last resort due to the severity of her disease but fortunately, Esperanza survived after three days using the machine.

Doctors may put patients on ECMO with serious but reversible lung or heart disease. Unfortunately, majority of ECMO patients are infants and children who suffer from meconium aspiration syndrome, pulmonary hypertension, respiratory distress syndrome, pneumonia, or congenital heart defect. A small percentage of ECMO patients are adults who suffers from pneumonia, trauma that affects the heart or lungs, cardiac failure, or severe infection.

Although ECMO can save lives, it comes with a price and risks. ECMO is a very expensive procedure. The estimated minimum cost for ECMO procedure alone is $74,000. If you include the pre- and post- ECMO procedures, the estimated minimum cost is $200,000. The average total hospital stay for ECMO procedure is 50 days. In addition to the high cost, ECMO is also a very risky procedure. Bleeding may occur due to the medication given to prevent blood from clotting in the tubing. Infection may develop at the site where the tubes enter the body. If the machine is not setup correctly, air bubbles may form in the tubing which leads to heart attack, stroke, and respiratory failure.

ECMO can save patients when other treatments fail. It is often used as a last resort procedure. ECMO does not cure an underlying disease but rather serves as a substitute until the heart and lungs can recover. Although it is still an emerging technology, ECMO has been showing promising results. The survival rate for patients with acute respiratory diseases who undergo ECMO is 50 to 70 percent. Due to the complexity of the procedure, an ECMO team may consists of only highly skilled physicians and nurses. According to Glassdoor, the average salary for nurses with ECMO skills is $87,000 per year and can go as high as $103,000 per year. If you are into nursing, ECMO is one specialty you can think about and if you are into technology, ECMO is something you can innovate.

References

Medline Plus
https://medlineplus.gov/ency/article/007234.htm

Medicine At Michigan
http://www.medicineatmichigan.org/sites/default/files/archives/bringing-lungs-bloom.pdf

The Healthline
https://www.healthline.com/health/extra-corporeal-membrane-oxygenation

Chauhan, S., Subin, S. (2011). “Extracorporeal membrane oxygenation, an anesthesiologist’s perspective: Physiology and principles. Part 1”. Annals of Cardiac Anaesthesia. 14 (3): 218–229. Retrieved May 7, 2014.

Dell Children’s
https://www.dellchildrens.net/services-and-programs/therapy-rehabilitation/ecmo/what-is-ecmo/

Children’s Hospital of Philadelphia
https://www.chop.edu/treatments/extracorporeal-membrane-oxygenation-ecmo

Oxford Academic
https://academic.oup.com/ejcts/article/37/2/339/774991

Hemmila, Mark R.; Rowe, Stephen A.; Boules, Tamer N.; Miskulin, Judiann; McGillicuddy, John W.; Schuerer, Douglas J.; Haft, Jonathan W.; Swaniker, Fresca; Arbabi, Saman (2004). “Extracorporeal Life Support for Severe Acute Respiratory Distress Syndrome in Adults”. Annals of Surgery. 240 (4): 595–605, discussion 605-7. doi:10.1097/01.sla.0000141159.90676.2d. PMC 1356461. PMID 15383787.

Glassdoor
https://www.glassdoor.com/Salaries/los-angeles-ecmo-rn-registered-nurse-salary-SRCH_IL.0,11_IM508_KO12,36.htm


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