ECMO is short for extracorporeal membrane oxygenation. Commonly pronounced “eckmoe,” it has been all over the news in the wake of COVID-19. It is a technology used at tertiary care centers like AdventHealth Tampa as a way to bypass the function of the heart and/or lungs by pumping oxygen-rich blood around the body. In many ways, ECMO is similar to the heart lung machine used by cardiac surgeons during open heart procedures. However, it can be used for longer periods of time.
Recently, ECMO has been used in our hospital to save lives of people with severe asthma, certain kinds of pulmonary embolisms, aspiration pneumonia, heart attack and inflammation of the heart muscle.
ECMO CPR is also an option. The National Heart, Lung and Blood Institute, part of the National Institutes of Health (NIH), recently made data from the ARREST trial public. This clinical trial sought to find out if ECMO was beneficial for patients in cardiac arrest. The ARREST trial was suspended for astoundingly good results. Without ECMO, only 1 of 15 patients survived cardiac arrest; with it, 6 in 14 patients lived. Based on these results, even in cases of cardiac arrest, ECMO can be an option when used appropriately and safely.
Rozales Swanson, MD, a cardiovascular and thoracic surgeon at the AdventHealth Tampa Pepin Heart Institute and codirector of the Advanced Heart Failure and Mechanical Support Program, says that ECMO is often used “as a bridge.” ECMO is only a temporary solution. It cannot cure by itself but it can be used until the patient’s needs can be addressed. Patients who need support for their heart and lungs and have no clear exit strategy may need to be placed on ECMO support. Then, when their clinical picture becomes clearer, a more advanced therapy such as a durable ventricular assist device (VAD) may be used to provide a more permanent treatment.
The Emergence of ECMO as a Heart and Lung Treatment for Adults
ECMO got its start back in the 1960’s, when it was first used in the neonatal intensive care unit to support preterm babies who had trouble breathing. “After the H1N1 epidemic, there was a big focus on using ECMO for adults, and this led to significant growth of the technology,” says Dr. Swanson.
This technology can be set up in different ways to provide the right support for patients. With VA ECMO, deoxygenated blood is drained from a vein to the machine. It is then returned to the artery as oxygenated blood. This setup supports both the heart and the lungs. However, patients who have cardiac function but need help with their lungs may receive VV ECMO. In this setup, deoxygenated blood is drained from the venous side and returned as oxygenated blood to the tricuspid valve in the heart. In fact, VV ECMO is proving to be a very valuable therapy in the current COVID-19 pandemic.
“For people who are progressing rapidly in severe COVID-19 disease, putting them on VV ECMO sooner rather than later can make a big difference for their survival,” says Dr. Swanson. The COVID-19 virus can overwhelm the immune system and attack the lungs via cytokine storm. However, ECMO can give patients’ lungs the time to heal while they receive advanced therapeutics and have time to recover.
ECMO as Part of a Larger System of Comprehensive Heart Care in Tampa
Patients on ECMO may eventually need to move on to another treatment, likely one that only the most advanced heart centers can provide. Because the Pepin Heart Institute is part of the larger AdventHealth system, patients have ready access to these complex heart solutions like durable VADs, heart-lung transplantation, and minimally invasive heart valve solutions such as transcatheter aortic valve replacement (TAVR) and MitraClip.
“We have a whole team of professionals, including cardiologists, pulmonologists and dietitians, contributing to what amounts to very comprehensive care for our heart patients,” says Dr. Swanson. “We work as a team so we can provide whole-person care at the Pepin Heart Institute.”
When you need comprehensive care for your heart, the AdventHealth Pepin Heart Institute can give you just that-and peace of mind. For a cardiology appointment or heart surgery consultation, visit PepinHeartTampa.com or call Call844-600-5151.