The Nebraska Medical Center ECMO Program
The Nebraska Medical Center's Neonatal ECMO program, which is the first Neonatal ECMO program in the state of Nebraska, was started in 1987. ECMO was first approved for use in the U.S. in 1984. When the Nebraska Medical Center's ECMO program started it was one of only a few ECMO centers in the whole country. The Neonatal ECMO program has since been used effectively to save the lives of hundreds of babies from Nebraska and surrounding states.
The Nebraska Medical Center's ECMO program is currently under the direction of Dr. Harold Kaftan, staff neonatologist, and Linda Pfeifer RN, ECMO Coordinator. The baby on ECMO, the ECMO pump and circuit are cared for by specially trained, highly skilled Nurses and Respiratory Therapists, referred to as ECMO Technicians. The ECMO team consists of ECMO Techs, Perfusionists, the attending Neonatologists, and Pediatric Surgeons. The ECMO team members work together, and coordinate their skills to provide the best possible care for the ECMO baby.
How ECMO Works
ECMO stands for ExtraCorporeal Membrane Oxygenation, and is also referred to as ECLS or ExtraCorporeal Life Support. This is a process which is used to treat critically sick infants by allowing the infants? lungs to rest and heal while an artificial lung oxygenates the blood. ECMO is performed through cannulas which are surgically placed in the baby's neck. The cannulas are attached to other tubes pre-filled with blood, called a circuit. Blood is removed from the baby and travels along the circuit to the artificial lung, called an Oxygenator, where oxygen enriched air is blown over the blood as it passes. There the blood is oxygenated and cleaned. The blood then passes through a tube within another tube which is called the Heat Exchanger. There the blood is rewarmed to body temperature and given back to the baby.
While on ECMO the ventilator which helps the baby breathe prior to ECMO is turned down to the lowest settings. This is the point at which the lungs are allowed to rest and heal. The artificial lung does all the work of breathing for the baby.
The Types of ECMO
ECMO is essentially the same kind of heart-lung bypass as used in many surgeries. The difference is that ECMO is performed for a much longer period. There are two types of ECMO, Veno-Venous (V-V) bypass and Arterio-Venous (A-V) bypass. Veno-Venous ECMO consists of a single cannula which is really two catheters in one. Arterio-Venous bypass involves two cannulas. The type of ECMO used depends on the baby and the type of illness they have.
Keeping Things Flowing Smoothly
The ECMO circuit is considered a foreign object to the immune system of the baby. Normally the immune system will attack such objects and make blood clots. To prevent this, while on ECMO the blood in the circuit is mixed with Heparin which slows the clotting process. While on ECMO lab tests are run regularly to ensure that the blood is clotting at a proper rate. The prolonged clotting time also means there is an increased risk of bleeding.
To help prevent bleeding and dislodging the cannulas the baby is sedated and given medicine for pain during ECMO.
Who ECMO Can Help
ECMO isn't for every sick baby, and babies who receive ECMO must meet specific criteria. ECMO is often used when other methods to help the baby have not worked. Types of complications which may require ECMO include Group B Streptococcal Pneumonia, Meconium Aspiration Syndrome, Diaphragmatic Hernia, Hyaline Membrane Disease, Pulmonary Hypertension, and Sepsis. Once the lungs have recovered ECMO is weaned off. The amount of time a baby will be on ECMO can take from a few days up to two weeks.
How ECMO is Discontinued
ECMO is discontinued much the same way as it is started. When it is decided that the baby is well enough that ECMO can be stopped, the tubing connecting the baby to the circuit is clamped and surgeons remove the cannulas. This is called Decannulation. The baby will still be on the ventilator to help assist with breathing. This will also be weaned as the baby improves.
What to Expect When ECMO is Finished
When ECMO is finished it doesn't mean that everything is fixed. The baby may still be very sick. Your baby may still require a ventilator to breathe and may still require antibiotics and other medications . Your baby may also require Oxygen for quite a while afterwards. It is not uncommon for babies who were on ECMO to go home on Oxygen.
The baby may also require special follow-up care because developmental problems. This is often caused by low oxygen levels during the time before ECMO. The follow-up helps to monitor your baby and look for any problems which can only be seen as the child grows up.
What to Do if You Want to Nurse Your Baby
While a baby is on ECMO he or she cannot nurse or bottle feed. The baby is given nutrition through special IV fluids. The best thing to do if you plan to nurse your baby is pump your breastmilk and freeze it until it can be used. Your baby can then be given the milk after recovering from being sick and on ECMO.
Babies who have been on ECMO can also have difficulty sucking and swallowing which will decrease over time. During that time the milk can be given through a special tube which is placed in the stomach. Please contact the Lactation Consultants or ask your Nurse if you have any questions or need any help.
For More ECMO Answers
Please contact the Neonatologists at 559-4442 or Linda Pfeifer 559-9616 with any questions about ECMO and your baby.