Extracorporeal membrane oxygenation (ECMO) is an advanced life-support system that can be used when a patient’s heart or lungs are unable to function properly on their own, despite maximum medical treatment. ECMO may be needed in cases of severe cardiac or respiratory failure, which can result from a range of heart and lung conditions. These include heart attack (myocardial infarction), cardiogenic shock, cardiomyopathy, pulmonary embolism, anaphylaxis, acute respiratory distress syndrome (ARDS) and other critical lung infections. Usually, this complex and intensive therapy is considered only after all other viable treatment options have been exhausted, such as the use of a breathing machine (ventilator) and special gases designed to relax the muscles in the walls of blood vessels connecting the heart and lungs (pulmonary vasodilators).
Tampa General Hospital (TGH) offers comprehensive ECMO services for patients experiencing life-threatening cardiac or respiratory failure. Our highly acclaimed and comprehensive Extracorporeal Membrane Oxygenation Program is recognized by the Extracorporeal Life Support Organization (ELSO) as a Center of Excellence in Life Support—a gold-level designation signifying the highest standard of achievement. Established in 1989, ELSO is an international nonprofit consortium of healthcare institutions, scientists, clinicians and industry partners. Its vital mission is to advance extracorporeal life support by fostering research, promoting education and encouraging collaboration across the global medical community.
ECMO Patient and Family Resources
In addition to providing groundbreaking treatment for cardiac and respiratory failure, TGH is committed to supporting our patients and their families with comprehensive educational materials and support services to help them better understand extracorporeal membrane oxygenation and what to expect during and after this lifesaving therapy. Our resources include detailed explanations of the ECMO procedure, its potential benefits and risks and the role of each member of our specialized ECMO team. We also offer customized services to support our patients and their family members—both emotionally and logistically—throughout the ECMO process, ensuring they have the guidance and care they need during this often challenging time.
What Is ECMO?
Also known as extracorporeal life support (ECLS), ECMO is a specialized treatment that acts as an artificial heart and lungs (or lungs only), providing critical support to the patient’s body when their cardiopulmonary organs are too compromised to function effectively. The duration of extracorporeal membrane oxygenation can vary depending on the patient’s overall health and response to therapy. In most cases, ECMO is used as a temporary support system for a few days to a few weeks, although some patients may require it for an extended period of up to several months.
There are two main types of extracorporeal membrane oxygenation:
- Venoarterial (VA) ECMO, which supports both the heart and lungs
- Venovenous (VV) ECMO, which supports the lungs only.
VA ECMO may be used in cases of simultaneous cardiac and respiratory failure, while VV ECMO may be considered if the heart is functioning adequately but the lungs are failing.
How Does ECMO Work?
In cases of severe cardiac or respiratory failure, extracorporeal membrane oxygenation is essential because every cell in the body needs oxygen to survive and thrive. When the heart and lungs are functioning properly, air is inhaled during the breathing process and the oxygen within it travels to the alveoli, tiny air sacs in the lungs. There, the oxygen passes through the thin walls of the alveoli into nearby capillaries and binds to the hemoglobin in red blood cells. These oxygen-rich red blood cells are then transported throughout the body via the bloodstream, delivering oxygen to various organs and tissues to support proper function. At the same time, the circulating blood collects carbon dioxide—a waste product of cellular activity—and transports it back to the lungs, where it is expelled from the body during exhalation, completing the respiratory process.
Cardiac and respiratory failure can severely disrupt the body’s ability to deliver oxygen to organs and tissues and remove carbon dioxide from the blood. Both functions are essential for survival. In cardiac failure, the heart cannot pump blood effectively, leading to poor circulation, oxygen deprivation in vital organs and fluid buildup in the lungs or other parts of the body. In respiratory failure, the lungs are unable to efficiently exchange gases, causing low oxygen levels (hypoxemia) or high carbon dioxide levels (hypercapnia) in the blood, which can impair organ function and lead to life-threatening complications.
Extracorporeal membrane oxygenation does not treat the underlying cause of cardiac or respiratory failure. Instead, it temporarily takes over the function of the heart and lungs (or lungs only), allowing these vital organs time to rest and heal from damage. While it is not a curative treatment, ECMO can provide critical support to the body, serving as a bridge to the recovery of heart or lung function, heart or lung transplantation or another definitive therapy, such as surgical repair of a congenital heart defect or large pulmonary embolism.
While a patient is on ECMO, several critical processes occur:
- Blood removal – Deoxygenated blood is drawn from the body through a cannula, which is inserted in the femoral or internal jugular vein and routed to an external machine.
- Oxygenation and carbon dioxide removal – Once inside the ECMO machine, the blood passes through an artificial membrane where oxygen is added and carbon dioxide is removed, simulating the gas exchange process of healthy lungs.
- Blood return – In VA ECMO, the oxygen-rich blood is pumped back into the body through a cannula inserted in an artery, such as the femoral or carotid artery. In VV ECMO, the blood is returned to a vein, not an artery.
Extracorporeal membrane oxygenation is typically administered in a hospital’s intensive care unit (ICU). During the treatment, the patient will remain sedated or unconscious to ensure comfort and minimize any bodily movement that could interfere with the procedure. The ECMO machine will be connected to the patient’s body via cannulas inserted in large blood vessels, with visible tubing carrying blood to and from the machine for oxygenation and carbon dioxide removal. Additional monitoring devices—such as a heart rate monitor, oxygen sensor and ventilator—may also be in use. Throughout the process, a specialized medical team will closely monitor the patient’s condition and manage the ECMO system to ensure optimal care.
What Are the Risks of ECMO?
Extracorporeal membrane oxygenation can be effective in providing short-term circulatory support for a patient with severe heart or lung failure, potentially buying valuable time for recovery or bridging to another definitive treatment, such as organ transplantation. However, its success rate can vary based on several unique factors, including the patient’s overall health and response to treatment.
If the patient does not improve with ECMO therapy, the dedicated medical team will perform a thorough assessment to determine the next steps. This process may include:
- Reassessing the underlying condition – The team will reevaluate the condition that is causing the heart or lung failure and, if it is determined to be treatable, consider other interventions.
- Exploring advanced therapies – If recovery seems unlikely, the patient may be considered for further treatment, such as organ transplantation (heart or lung) or another surgical procedure.
- Involving the family – The medical team will communicate with the patient’s loved ones about the prognosis, likelihood of recovery and risks of continuing ECMO therapy.
- Transitioning care – If the patient’s condition is deemed irreversible and other treatment options are not feasible, the medical team may discontinue ECMO support and focus instead on improving the patient’s comfort and quality of life.
Extracorporeal membrane oxygenation can have several long-term effects, although the risk and severity can vary depending on the patient’s condition, the duration of ECMO support and any issues that arise during treatment. Potential complications include:
- Organ damage – Prolonged use of ECMO can strain certain organs, such as the kidneys and liver, due to poor blood circulation or other side effects of treatment. Some patients may experience long-term kidney problems or require dialysis.
- Neurological issues – ECMO can increase the risk of neural problems, such as stroke, brain hemorrhage and cognitive impairment, especially if the patient has low blood oxygen levels over an extended time.
- Infection – The invasive nature of ECMO, which involves the insertion of cannulas into large blood vessels, can increase susceptibility to infection, particularly at the cannula insertion site or in the bloodstream.
- Bleeding and blood clots – The use of anticoagulants to help prevent blood clotting during ECMO can increase the risk of excessive bleeding. Additionally, whenever a catheter is inserted into an artery or vein, the blood vessel wall may become irritated or inflamed, which can lead to the development of small blood clots.
- Muscle weakness – Prolonged bed rest and immobility often lead to physical deconditioning. Therefore, a patient who requires long-term ECMO support may develop muscle weakness, joint stiffness and difficulty regaining strength.
During ECMO: Visiting the Patient and My Role As a Family Member
During extracorporeal membrane oxygenation therapy, the patient will receive attentive and ongoing care from a highly specialized medical team, which typically includes:
- Cardiothoracic surgeons – After initially placing the ECMO cannulas in the patient’s chest or groin, a surgeon will oversee the treatment process and ensure optimal function of the ECMO system.
- Intensivists – Critical care physicians will manage the patient’s overall condition, monitor vital signs and adjust the ECMO settings as needed.
- ECMO specialists – Highly trained nurses, respiratory therapists and perfusionists will operate the ECMO machine, continually monitoring the patient’s blood flow, oxygenation and other critical parameters.
- ECMO support staff – Other medical professionals will assist with the patient’s daily care, which may include managing medications, administering fluids and providing general comfort.
- Physical and occupational therapists – If the patient remains on ECMO support for an extended period, a physical or occupational therapist can provide rehabilitative services to help prevent muscle weakening and decreased functional ability.
Family members can further promote the patient’s well-being by providing emotional support, offering additional comfort and staying informed about the treatment plan. While the medical team focuses on clinical care, loved ones can contribute by advocating for the patient’s needs, offering reassurance and fostering a sense of stability during ECMO treatment and recovery.
When visiting a patient who is receiving extracorporeal membrane oxygenation therapy, family members and friends should be sure to:
- Follow all hospital guidelines – Medical centers have specific rules in place regarding the permissible number of visitors, visitation hours and infection control protocols.
- Stay calm and supportive – ECMO patients are typically hospitalized in a critical care setting and may be heavily sedated or unconscious, so it is important to maintain a peaceful environment.
- Limit physical contact – Visitors should not touch or otherwise interfere with the medical equipment, such as ECMO tubing, and be mindful of the sterile environment of the ICU.
- Ask questions – Family members should feel free to communicate with the medical team to better understand the patient’s progress, voice any concerns and stay informed about the next steps.
What Sets TGH Apart for ECMO
A respected leader in ECMO therapy, TGH is distinguished by our commitment to delivering highly specialized patient care and incorporating the latest technological innovations. We are especially proud to be one of the top five hospitals chosen to roll out the groundbreaking Medtronic VitalFlow ECMO pump, the first and only FDA-approved extracorporeal membrane oxygenation pump designed for use beyond eight hours. This milestone embodies the passion and dedication of our clinicians, who shared valuable insights with their peers across the United States to make VitalFlow a reality in bridging the gap between bedside care and intra-hospital transport.
Another key feature that sets TGH apart is our ability to ambulate patients while they are on ECMO support, a practice that allows for more aggressive rehabilitation and can lead to a faster recovery. This unique capability has helped make TGH a trusted referral center for physicians seeking optimal care for their patients.
TGH prioritizes patient care over financial constraints, ensuring that every patient receives the best and most appropriate treatment. We also offer comprehensive education and support services, further underscoring our dedication to understanding and meeting the emotional and physical needs of our patients and their loved ones. For these reasons and others, TGH has earned a reputation as a regional leader in extracorporeal membrane oxygenation therapy, providing exceptional, compassionate care and innovative solutions for those in critical need.
If you would like to refer a patient to Tampa General Hospital for ECMO support, please contact the TGH Transfer Center at (800) 247-4472. We ask that you provide all necessary patient information, including diagnosis, reason for transfer and your contact details as the referring physician.