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Extracorporeal Membrane Oxygenation
Therapy (ECMO)
Mary Ann Degges, DNP, RN, CNL, CCNS
Advanced Nursing Coordinator
Cardiovascular Services
Page 2
ECMO
AKA extracorporeal life support (ECLS)
Venoarterial (VA) support
Venovenous (VV) support
Page 3
ECMO
Achieved by draining
venous blood,
removing carbon
dioxide and adding
oxygen through an
artificial lung, and
returning the blood to
the circulation via
either the venous or
arterial circulation.
http://www.youtube.co
m/watch?v=XWTOBZy
eoQw
Page 4
ECMO
VA ECMO VV ECMO
Page 5
ECMO
Central Cannulation
Page 6
ECMO
Indications for adults:
Adult respiratory failure
Influenza
Carbon monoxide poisoning
Cystic fibrosis (bridge-to-transplant)
Sepsis
Cardiac failure
Cardiogenic shock
Bridge to VAD or transplant
Inability to wean from cardiopulmonary bypass
Page 7
ECMO-Nursing Considerations
Usual ICU care
Cannula securement and insertion site
Limb monitoring
Anticoagulation
Sedation and pain management
ECMO specialist
Patient and family centered care
Page 8
ECMO Case 1
Carbon monoxide
poisoning
Page 9
ECMO Case 1
38 year old critically ill with multisystem organ
failure due to carbon monoxide poisoning
Placed on VA ECMO for 5 days
Woke up after 9 days and was neurologically
appropriate
Weaned from ECMO and eventually
discharged to home
http://www.newschannel5.com/story/24088405/holiday-miracle-
for-mid-state-family
Page 10
ECMO Case 1
Page 11
ECMO Case 2
24 year old female admitted with acute onset of
hypoxia, tachycardia and hypotension
Oxygen saturation 80% at OSH requiring
urgent intubation
Oxygen saturation on 100% with PEEP of 5 cm
was in the 70s during transfer to UABH
Questionable pneumonia versus pulmonary
edema secondary to heart failure
34 weeks gestation
Page 12
ECMO Case 2
Bedside ECHO revealed LVEF of 15-20%
Unresponsive to conventional medical therapy
Unable to obtain fetal heart tones-fetal demise
Placed on VA ECMO
Etiology unclear:
Sepsis/ARDS
Peripartum cardiomyopathy
PTE
Page 13
ECMO Case 2
On day after admission, patient went into labor
and baby was delivered
Right after delivery ST segment changes were
noted in anterolateral leads of ECG
Taken to cath lab-coronary arteries were clean
ECMO flow decreased and IABP placed
LVEF steadily improved and ECMO
decannulation occurred on day 5
Residual RV dysfunction with PHTN
Page 14
ECMO Case 3
25 year old female transferred from OSH with
pneumonia and respiratory distress
24 weeks gestation-fetal tones heard
Upon arrival to OB service at UABH, oxygen
saturation 88-90% with RR 50s
MET activated-intubated and sedated
Tested + for mycoplasma pneumonia at OSH
Sepsis and ARDS
Page 15
ECMO Case 3
Transferred to MICU service but not
responsive to conventional therapies
Placed on VV ECMO a few days before
Christmas and was decannulated on Christmas
Day
Her condition continued to improve and she
was discharged to home in early January
Followed by OB/GYN throughout
hospitalization
Page 16
ECMO Case 3
Follow-Up Visit After Hospital Discharge
Page 17
Watts battles H1N1 at UAB
Andalusia Star News
Page 18
Thank You!
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