Extracorporeal Membrane Oxygenation, often called ECMO, is a specialized medical intervention that provides temporary support for individuals experiencing severe heart or lung failure. This life support system takes over the work of these organs, allowing them to rest and heal. It plays a significant role in supporting newborns with life-threatening cardiorespiratory conditions, offering a bridge to recovery or further medical treatment.
What is Neonatal ECMO?
Neonatal ECMO is the application of Extracorporeal Membrane Oxygenation for newborns. This treatment acts as a temporary heart-lung bypass, supporting infants whose hearts or lungs are too compromised to function effectively. Its primary goal is to provide adequate oxygenation and remove carbon dioxide from the baby’s blood, allowing their organs time to recover.
The system does not cure the underlying condition but offers a period of rest for the damaged organs. It serves as a bridge to recovery of the baby’s native heart and lung function, or to other definitive treatments, such as organ transplantation. ECMO is considered when conventional medical therapies have been maximized and the infant’s condition continues to worsen, indicating a high risk of mortality without this intervention.
How Neonatal ECMO Supports Babies
The ECMO system circulates the baby’s blood outside the body through a closed circuit. Blood is drawn from the baby, typically from a large vein in the neck or groin, through a specialized tube called a cannula. This deoxygenated blood travels through the ECMO machine, which includes a pump that propels the blood, mimicking the heart’s pumping action.
The blood then enters an artificial lung, known as an oxygenator or membrane lung, where it undergoes gas exchange. Carbon dioxide is removed, and oxygen is added to the blood, much like healthy lungs would do. After being oxygenated and warmed by a heat exchanger, the blood is returned to the baby’s circulatory system through another cannula: either into a vein (veno-venous ECMO for lung support) or an artery (veno-arterial ECMO for heart and lung support).
Conditions Requiring Neonatal ECMO
Neonatal ECMO is considered for newborns with severe respiratory or cardiac failure that has not responded to other medical interventions. Common respiratory conditions include Meconium Aspiration Syndrome (MAS), where a newborn inhales meconium (first stool) during birth, leading to lung distress. Persistent Pulmonary Hypertension of the Newborn (PPHN) is another indication, characterized by high blood pressure in the lung arteries, impeding oxygen uptake.
Congenital Diaphragmatic Hernia (CDH), a birth defect where abdominal organs protrude into the chest cavity, can severely impair lung development and function, often necessitating ECMO support. Severe pneumonia or other forms of acute respiratory distress syndrome that do not improve with conventional ventilation are also reasons for ECMO. For cardiac issues, ECMO may be used for congenital heart defects, such as hypoplastic left heart syndrome, or severe heart muscle inflammation (myocarditis), providing support until surgical repair or recovery.
The ECMO Journey and Recovery
The duration of neonatal ECMO support ranges from a few days to several weeks, depending on the baby’s condition and how quickly their organs recover. During this period, a specialized team of healthcare professionals, including neonatologists, cardiac intensivists, ECMO specialists, nurses, and respiratory therapists, continuously monitors the infant. This team observes the baby’s vital signs, blood parameters, and the ECMO circuit’s performance to make necessary adjustments.
Maintaining the ECMO circuit requires careful management, including medications to prevent blood clotting and ensure the baby’s comfort. Bleeding, particularly at the cannulation site or internally, is a concern due to necessary anticoagulation; frequent monitoring, including head ultrasounds, detects issues. Infection is another consideration due to the procedure’s invasive nature; close attention is paid to sterile techniques and infection prevention.
As the baby’s heart and lungs show signs of improvement, the ECMO support is gradually reduced, a process known as weaning. This allows the baby’s organs to progressively take over more work. Following successful removal from ECMO, rehabilitation is often necessary to help the infant regain strength and developmental milestones. Outcomes for babies who receive ECMO vary, influenced by the severity of their initial illness and associated conditions, but overall survival rates for neonates on ECMO are approximately 80%.