Who needs ECMO support?
ECMO is used when a baby or child has a condition which prevents the lungs from working properly,
i.e. transferring oxygen into the blood and removing carbon dioxide. Less frequently, ECMO is
used to support patients who have heart failure.
Starting ECMO
An operation is required to insert the tubes (cannulae) which will carry the blood from the baby to the ECMO
circuit and back again. This will be performed in the ward to prevent moving the baby but it is done in exactly the
same way as it would be done in an operating room. Operating room nurses assist the surgeons. ECMO nurses and another ECMO
doctor makes sure the baby is stable, well sedated and pain-free throughout the procedure.
(A similar operation may be needed at the end of the ECMO run to remove the cannulae.)
The first cannula is inserted into the right side of the baby's heart through a large vein in the
neck. This carries blood which is low in oxygen and high in carbon dioxide into the circuit. You will notice that this blood
is dark.
In Veno-arterial ECMO (the kind Theresa has), the second cannula allows blood which has passed
round the circuit and is now high in oxygen and low in carbon dioxide to re-enter the baby into a main artery and circulate
around the body.
This process means that the ECMO circuit provides an artificial lung and allows
the baby's lungs to rest and recover. The baby will be given medication so that the cannulae will not cause discomfort.
Where possible your child will be able to open his/her
eyes and move arms and legs. Sedation will only be given for comfort and to prevent the cannulae being dislodged.
On ECMO Support
Blood from the first cannula drains by gravity. To help the blood flow it is necessary to have the bed
or cot high - meaning the smaller nurses may have to stand on a box to change the diaper! The
ECMO circuit has a safety device which will stop the pump if the blood flow
decreases. 
Fluids and medicines can also be given into the ECMO circuit.
The ECMO pump controls how quickly the blood flows through the circuit. By adjusting the flow we can control how much oxygen
is returning to the baby. As the baby’s lungs improve we can gradually reduce this flow until she is ready
to cope on her own. The length of time this takes varies from baby to baby and you may find the pump flow rate will go up
and down throughout the day
The oxygenator is the most important part of the ECMO circuit and acts in the same way as a healthy lung. Blood flowing
through it has oxygen added and carbon dioxide removed. The levels of these two substances can be controlled by adjusting
the gas flow meters. The blood leaving the oxygenator is bright red due to it’s high oxygen content.
As the blood flows round the circuit it cools down. Before it can be passed back into the baby’s body it needs to
be re-warmed The blood flows inside the metal rods of the heat exchanger while water warmed to the right temperature by the
water heater flows around them heating the blood back to body temperature.
The ECMO profusionist will have to explained add heparin (an anti-coagulant) to the blood flowing through the circuit
to prevent it from clotting. The profusionist and ECMO nurse check the clotting time (ACT) of the blood in the circuit
every one to two hours and adjust the heparin infusion to keep this at the best level to minimize the risk of bleeding.
While on ECMO, it will be possible to reduce the need for the ventilator and allow the doctors to give appropriate
respiratory care.
While Theresa is on ECMO she will get all the protein, fat, vitamins and minerals needed
directly into the circuit until she is able to feed. Then, she will begin tube feeding with the stored breast milk
I have pumped.
* all the technical information is from the "Department of Surgical Paediatrics - Glasgow" website www.gla.ac.uk/departments/surgicalpaediatrics/ecmoinfo.htm
