The use of extracorporeal membranous oxygenation (ECMO) to treat severe adult cardiac and respiratory failure has increased in the past decade, due to supportive evidence, advances in extra-corporeal technology, and increased clinical experience.
In 2011, University Hospital Geelong implemented a structured ECMO program. This included Intensivist training in cannulation and care for the ECMO patient, nurse credentialing in maintenance of ECMO, updating equipment, establishing a formal relationship with a high-volume ECMO service, and regular audit cycle. Our service provides both veno-veno and veno-arterial ECMO services, and now performs more than 15 ECMO runs per year.
ECMO is used for patients with severe forms of heart or lung failure (or both) when other treatments cannot keep them alive and their condition is reversible. ECMO may be used in the setting of various conditions but the most common conditions are:
- Severe pneumonia or lung infection (i.e Influenza/flu or COVID)
- Pulmonary embolus (blood clot in the lung)
- Following a heart attack
- After open heart surgery where the heart is failing to respond to usual medications.
ECMO works by draining poorly oxygenated blood from the body, pumping the blood through an oxygenator, then returning well-oxygenated blood back to the body.
ECMO is usually required without much warning. For this reason, there is often no time to discuss the associated risks. Where possible, when there is time, the risks associated with ECMO can be discussed, which are typically bleeding and infection. However, ECMO is usually considered to be the last resort with no other alternatives for patients who are otherwise likely to die from their illness.
Bleeding
Bleeding is the most common risk associated with ECMO as medication is required to prevent clots from forming in the ECMO circuit which have the potential to block the circuit and stop it from working. Bleeding may be minor and appear as ooze around the cannula entry site or major, resulting in a stroke or significant blood loss. Patients are monitored closely for any signs of bleeding and dosing of the medication used to prevent clots is adjusted frequently. It is not unusual for patients to require transfusions of blood or other blood products throughout ECMO treatment.
Infection
Any foreign device in the body increases the risk of infection, despite being inserted in a sterile manner. Patients are closely monitored and antibiotics are started immediately if any signs of infection appear.
Your loved one will be cared for in the Intensive Care Unit by our multidisciplinary team. One or two dedicated nurses with specialised training in ECMO will be at the bedside and they will also have medical staff with ECMO specific training closely monitoring and reviewing them frequently. Our ECMO specialist team will meet at the bedside regularly to discuss the progress of your loved one as well as via video conference with the Alfred ECMO team for input and advice.
Due to the nature of their illness, you can expect that they may be in the Intensive Care Unit for some time. Whilst it is difficult to say how long, our staff will update you daily with what to expect and plan for. Our dedicated social worker can provide you with further support and information.
Our ECMO nurses and doctors are highly competent and can answer any questions you may have about your loved ones’ progress, condition, equipment, medication etc. You can also access more information about ECMO online:
Victorian Extracorporeal Membrane Oxygenation Service – VECMOS
Extra corporeal membrane oxygenation (ECMO) – My Life After ICU
Extracorporeal Life Support Organization | ELSO | ECMO
Ajay's ECMO survival story
Early in 2023, Ajay Manchandani feared for his life. After contracting abdominal pains that lasted for a few days, Ajay presented himself to Werribee Mercy Hospital where he began having shortness of breath. Whilst admitted, they detected pneumonia, a bacterial infection in the bloodstream and numerous blood clots.
Ajay was transferred to Sunshine Hospital where he was put on a ventilator, but the decision was made to put Ajay on ECMO (extracorporeal membrane oxygenation) here at University Hospital Geelong.
Ajay was on ECMO for 39 days which ultimately saved his life. Ajay has no recollection of the events that transpired whilst on ECMO, but he is extremely grateful for those that helped him during his ordeal.
“I’m extremely grateful. I keep thinking about everyone who looked after me here and I don’t have enough words. Each one of them were all so kind, supportive, loving and caring. It was just amazing. Even the nurses in the regular wards were so caring”, Ajay said.
“They made me feel comfortable because when I woke up I kept thinking about what happened and if I did something wrong or if it will happen again. But all the doctors were helpful to make me comfortable and reassure me.”
ECMO can be used for both cardiac and respiratory failure. In Ajay’s case it was used for respiratory failure.
“The blood is taken from the patient via a cannula and circulated through a pump and oxygenator where the blood is oxygenated and carbon dioxide removed. It is then returned back to the patient via a separate cannula. Patients can have no respiratory function and are fully supported on VV ECMO while their lungs recover”, said ECMO coordinator Lucy Range.
Ajay and his family stopped by ICU to reunite and give presents to those that helped save his life. Ajay is now in full recovery and is slowly returning to work and resuming other activities he enjoys.
Page last updated: August 27, 2024