Extra-Corporeal Membrane Oxygenation (ECMO)

Extracorporeal Membrane Oxygenation (ECMO) is a life-saving advanced intensive care technique that is used when a child or adult’s lungs or heart are unable to function properly. It entails a machine that will take over the work of the heart and lungs until they recover (enhanced heart – lung device in ICU). It’s only used when all other treatments have failed or stopped working.

Centrimag can keep a patient alive for days to weeks. Centrimag technology has a proven track record in a number of conditions, particularly in children, and it necessitates a committed team of medical and paramedical experts providing round-the-clock bedside care.

The parts of a Centrimag set up include a vascular cannula, blood pump (controls blood flow), oxygenator (oxygenates blood and eliminates carbon dioxide), blood warmer, and tubing through which the blood flows.

Extracorporeal membrane oxygenation (ECMO) is a complex system that works similarly to a heart-lung bypass device used in open heart surgery. When a patient is connected to ECMO, blood flows through tubing to the machine’s artificial lung, which adds oxygen and removes carbon dioxide. The blood is then warmed to body temperature before being pumped back into the body.

What is the use of ECMO?

ECMO can be used in people of all ages, from infants to adults, who have heart or lung problems or are recovering from a heart transplant.

ECMO can be used to treat the following heart conditions:

  • Life-threatening Infection
  • Congenital Heart Defects.
  • Low Body temperature.
  • Myocarditis
  • Complications following a transplant
  • Myocardial infarction (acute)
  • Heart Muscular Diseases
  • Cardiogenic Shock

ECMO can be used to treat the following lung conditions:

  • Coronavirus (COVID-19)
  • Blocked pulmonary artery in the lungs.
  • Acute respiratory distress syndrome (ARDS)
  • Meconium aspiration syndrome (MAS)
  • Severe High Blood Pressure in the lungs’ arteries (PPHN)

Indications for ECMO

  • Patients who require breathing assistance.
  • Patients who require both cardiac and respiratory assistance and have severe symptoms
  • While CPR (cardiopulmonary resuscitation) is being performed, ECMO may be required.

When a patient has a life-threatening systemic illness such as severe pneumonia (ARDS), heart failure, cardiorespiratory failure (reversible) caused by infection, or surgery, and all other types of medical therapy have failed to provide significant improvement.

Simultaneously, it must be applied cautiously and quickly in situations that are known to be reversible with time and adequate medical therapy (infection, pneumonia, reversible heart dysfunction). It’s important to realize that ECMO isn’t a cure; rather, it helps to rest the sick heart and/or lungs, giving them time to recuperate.

What is the ECMO Machine and how does it work?

The ECMO machine is attached to the patient via a Cannula, which is a plastic tube that is inserted into large veins and arteries in the leg, neck, or chest. The ECMO Machine removes blood from the patient and pumps it through an artificial lung, replacing oxygen and carbon dioxide, before returning the blood to the patient via a pump that replaces the heart’s function.

What are the different ECMO modes?

ECMO can be used in two ways, depending on the treatment plan:

Veno-Arterial ECMO (VA ECMO):

One type of ECMO that maintains both lung and heart function is Veno-Arterial ECMO (VA ECMO). On the side of the neck, direct into the chest, or in the leg, two cannulas are put, one in a large vein and the other in a large artery. The ECMO system will draw blood from a vein, add oxygen, and remove carbon dioxide before returning the blood to an artery and pumping it throughout the body.

Veno-venous ECMO (VV ECMO):

It is another type of ECMO that only supports lung function. In large veins on the side of the neck or in the leg, one or two cannulas are inserted. Whether one or two cannulas are placed depends on the patient’s condition. It circulates blood from the heart to arteries, which transport oxygenated blood to organs and other bodily tissues, allowing the lungs to rest and recover quickly.

What happens to patients on ECMO?

Continuous Monitoring of the patients while on ECMO:

Patients on ECMO will be monitored 24 hours a day to monitor their heart rate, blood pressure, and oxygen levels. Blood is checked on a regular basis to monitor carbon dioxide and oxygen levels, as well as to ensure that the blood is thin enough. All of these tests are performed to ensure that the ECMO machine is supporting the patient’s health and to make any necessary adjustments.

Preventing lung infections while on ECMO:

Patients may get lung infections as a result of mucus formation. The mucus is taken out of the lungs by an endotracheal tube (ET tube). This aids in the removal of mucus and infection from the lungs.

Healing of the Lungs while on EMCO:

When a patient is on an ECMO machine, it temporarily takes over lung function and aids in lung recovery.

Allowing patients to do movements while on ECMO:

Patients are given medication to relieve discomfort and make them more comfortable while on ECMO. While some patients are awake and able to communicate and interact while on ECMO, these medications may make them tired. While on ECMO, some patients are active and able to walk.

Nutritional Support During ECMO:

Patients receive nutrients from a variety of sources, including central venous nutrition (CVN) and lipids (CVN provides essential vitamins, electrolytes, and fats) medication is administered through a vein. The nutrients are given in liquid form directly into the stomach through a tube to some patients who have an Endotracheal Tube (ET tube).


An organ or numerous organs are injured over the course of a disease and require time to recover and repair with the help of suitable medical treatment. If the organ must continue to function under these conditions, the strain on the organ increases.
For example: A weak heart failing after corrective cardiac surgery requires time to recover. ECMO acts as an artificial heart and lung, allowing the heart and/or lungs to rest or recuperate.

How Does an EMCO Operate?

Deoxygenated blood or impure blood is drained and run through a pump (external or artificial heart) and an oxygenator (artificial or external lung) along with a sweep gas flow system to entrain oxygen and remove carbon dioxide from the blood through a tube (catheter) placed in a large vein (in the patient’s neck or groin). This oxygenated or pure blood will appear bright red, and it will be pumped back into the patient at the same rate as his or her heart rate.

The ECMO (extracorporeal membrane oxygenation) machine includes:

  • TUBINGS, which operate as channels to transport blood from the infant to the machine and back to the youngster, are among the machine’s components.
  • PUMP, to take and give blood to the child.
  • MEMBRANE, through which blood is pushed by the pump to remove carbon dioxide and add oxygen.
  • HEMOTHERM, maintains body temperature by warming the blood.

Is EMCO a safe choice?

The devices and circuits used in ECMO have evolved through time, and safer, longer-lasting materials are now being employed, reducing the need for regular circuit changes. Due to complications such as bleeding and an increased demand for blood products, this was a common problem in the past. These issues have already been greatly reduced, and ECMO is now safer in the hands of expert and qualified professionals, minimizing procedure-related complications in experienced units.

What are the risk factors of ECMO?

Despite the fact that ECMO is a life-saving operation, it is associated with a number of risks due to its complexity, including:

Bleeding: Patients on ECMO require blood-thinning medicine because they may experience bleeding in many sections of their bodies (brain, lungs, insertion sites of the cannula). Because bleeding can be life-threatening, the patient will be given drugs to help in the clotting of the blood. Surgery may be required in rare circumstances to stop the bleeding. If the patient’s blood count falls below a certain level, blood and blood platelets are given to him.

Thromboembolism (blood clot): Blood clots or air bubbles can form inside the ECMO tubing. As a result, while the patient is on ECMO, the healthcare team closely watches for blood clots or air bubbles. Heparin is a drug that prevents blood from clotting. This reduces the likelihood of an air bubble reaching organs or a blood clot obstructing a blood vessel, allowing blood to enter the organ.

Infection: The infection might start at the point where the tubes enter the body and spread to the lungs or other parts of the body. Antibiotics will be provided to the patient if any signs of infection are discovered.

Stroke: When a patient is on ECMO, small blood clots in the brain can prevent some parts of the brain from receiving enough blood flow. This can result in a stroke, and some parts of the brain may be permanently damaged. What difficulty a person may get as a result of a stroke is determined by the affected portion of the brain. A stroke can impair a person’s ability to move various body parts, see, recall, speak, read, or write. Only a few people who have had a stroke will be able to regain function. Strokes are extremely rare, occurring in less than 5% of patients on ECMO.

Is EMCO/ Centrimag Expensive?

ECMO is an expensive and labor-intensive skilled procedure. The use of ECMO necessitates the use of skilled surgeons, anesthetists, intensivists, perfusionists, nurses, and reliable laboratory services. It necessitates periodic blood tests and the use of blood products. However, in today’s Indian context, it is also becoming an economical treatment option.

  • Managing a patient on ECMO necessitates the participation of a multidisciplinary team.
  • Cardiac surgeons are part of our team.
  • Anesthesiologist
  • Intensivist.
  • Cardiologist
  • Perfusionist
  • Nurse who specializes in cardiology

With a committed team, at ABC we have an active Centrimag program. Our Centrimag experience is slowly building up with the best outcomes.


ECMO is a difficult yet life-saving technique that can help patients in severe situations. The success rates of ECMO, on the other hand, are dependent on the severity of the patient’s health condition that necessitated its use. According to the patient’s condition, the doctor will explain to what extent ECMO can be beneficial.
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