Health Innovations

What is ECMO?

ECMO (pronounced “eck-moe”) is an extracorporeal membrane oxygenation treatment that provides short-term emergency life support for patients with a failing heart, lungs or both. ECMO is a machine that replaces the function of the heart and/or lungs for patients, allowing physicians time to treat patients suffering from the most critical conditions. For example, ECMO is used during life-threatening conditions such as severe lung damage from infection, shock after a massive heart attack, or — more recently — for patients suffering from severe cases of coronavirus.

“As Greater Cincinnati’s first and most experienced adult heart transplant program, we believe no one should have to leave the region to receive the care they need, especially patients who are critically ill or injured,” said Suzanne Bennett, MD, UC Health anesthesiologist intensivist and associate professor of anesthesiology and critical care medicine at the UC College of Medicine. “ECMO provides the medical team time, so we can give the patient the necessary therapy to treat the underlying illness or injury that is causing the patient’s heart or lungs to fail.”

How does ECMO work?

ECMO removes blood from the body through tubes surgically placed in veins or arteries, then oxygen is added and carbon dioxide is removed from the blood before it returns to the body. Patients are given medication to thin their blood to prevent clotting, which helps the ECMO machine work at full capacity. Additionally, patients receive frequent imaging while labs are performed to assist with their care.

“As a cardiac surgeon, I put people on cardiopulmonary bypass every day,” said Louis Benson Louis IV, MD, chief of Cardiac Surgery at UC Medical Center. “The ECMO circuit is just another form of cardiopulmonary bypass, but we now take it out of the operating room to the patients’ bedside. We’re working together in order to improve their care.”

Multidisciplinary Care Team: Saving Lives with Science and Expertise

While ECMO does not treat the heart or lung condition, it does support the body as the illness is treated by UC Health experts. The ECMO machine gives the patient a chance to recover and have a meaningful life. The multidisciplinary care team includes the following:

• Physicians and nurse practitioners: Provide and direct the care of the patient and ECMO machine.
• ECMO specialists and perfusionists: Monitor changes to the patient and ECMO machine. 
• Nurses: Provide bedside care and management of the patient.
• Respiratory therapists: Provide bedside care and monitor the ventilator.
• Pharmacist: Provides medication recommendations.
• Dietitian: Provides nutritional recommendations.
• Social workers: Assist patients and families in navigating their illness and injury through recovery.
• Physical/occupational/speech therapists: Provide guidance and support to promote mobility, functionality and speech.

To provide patient and family-centered care, daily rounds are performed by the care team directly involved in treating patients on ECMO.

How has ECMO helped with critically ill COVID-19 patients?

“We bring together the clinical expertise of so many teams across UC Health, 24 hours a day, seven days a week, to focus all of our efforts and decisions in saving the lives of these critically ill patients,” said Dr. Bennett, who serves as director of the ECMO program at UC Health. “And ECMO is often their last hope for survival. With the use of ECMO, we do the work of the heart and lungs while patients’ organs recover.”

ECMO is a highly advanced machine, so not every hospital system provides ECMO support for patients. As an academic health system, UC Health participates in international research studies, which confirm that patients with severe cases of COVID-19 who are placed on ECMO experience better survival outcomes in comparison to patients not placed on ECMO. This data is similar to the survival rate for patients treated with ECMO in previous outbreaks of lung-damaging viruses. UC Health has had excellent outcomes with the use of ECMO as a bridge to recovery in COVID-19 patients.

What is life like after ECMO?

At UC Health, the care team carefully evaluates a patient’s condition to determine if the underlying illness is improving. There are a couple of steps that take place to do this, which include:

• To ensure the illness has improved enough for ECMO support to be removed, the care team begins a testing process to wean a patient off ECMO.
• After removal of ECMO, patients remain in the Intensive Care Unit (ICU) for close monitoring until they are stable enough to move out or be discharged to a rehabilitation facility.
• Quality of life is achievable after completing hospitalization and rehabilitation courses.

How long can a patient be on ECMO?

Every case for a patient is different, so there is no definitive timeline in regards to how long a patient will be on ECMO support. Depending on the case, it is possible for patients to require ECMO support for weeks.

UC Health Provides Palliative Care Support for ECMO Patients

While ECMO has greatly improved survival rates for critically ill patients, it does not save every case. In up to half of patients on ECMO, the challenge to the body is too great, and the patient passes away. If the underlying illness cannot be cured, ECMO support is turned off, and then the care team focuses on comfort and providing a natural death. ECMO is a surgical procedure that is not without risk, so a UC Health physician discusses these risks in detail.

The Promise of Academic Medicine

UC Health participates in academic research at the local, state and international level to better study and understand COVID-19. At the local level, UC Health interacts with other hospitals that share their ECMO pumps in order to ensure UC Health does not have to turn patients away.

“We are partnering with other major academic institutions in the state to try and improve ECMO care,” Dr. Louis said. “At the international level, as a participant in the COVID-19 consortium, we are sharing our data so we can understand how to best care for COVID-19 using this lifesaving procedure. This is the promise of academic medicine.”