33946 Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; initiation, veno-venous

Name of the Procedure:

Extracorporeal Membrane Oxygenation (ECMO)/Extracorporeal Life Support (ECLS) - Veno-Venous Initiation

Summary

Extracorporeal Membrane Oxygenation (ECMO) is a life-support treatment that uses a pump to circulate blood through an artificial lung back into the bloodstream of a person whose heart and lungs are not functioning properly. The veno-venous (VV) type of ECMO provides respiratory support by oxygenating the blood.

Purpose

ECMO is used to provide cardiac and respiratory support to patients whose heart and lungs are severely compromised. The primary goal is to maintain adequate oxygenation and carbon dioxide removal while the underlying condition that is impairing heart and lung function is treated or as a bridge to recovery or further surgical interventions.

Indications

• Severe respiratory failure unresponsive to conventional mechanical ventilation.
• Acute respiratory distress syndrome (ARDS).
• Severe cases of pneumonia or influenza.
• Severe trauma leading to compromised lung function.
• As a bridge to lung transplantation.

Preparation

• Patients typically undergo several diagnostic tests including blood tests, chest X-rays, and echocardiograms.
• Pre-procedure instructions may include fasting for several hours if anesthesia is used.
• Adjustment or discontinuation of certain medications might be needed.

Procedure Description

1. An incision is made and cannulas (tubes) are inserted into large veins, usually in the neck or groin.
2. Blood is drained from the body via the cannulas and pumped through an oxygenator machine.
3. The oxygenator adds oxygen to the blood and removes carbon dioxide.
4. The oxygenated blood is then returned to the patient’s venous system.
5. Throughout the procedure, the patient is closely monitored, and adjustments are made as needed.

The procedure requires specialized equipment including an ECMO machine, monitoring devices, and sterile surgical instruments. Sedation or anesthesia is often used to ensure patient comfort.

Duration

Initiating ECMO typically takes 1 to 2 hours, but the total duration of ECMO support may range from a few days to several weeks, depending on the patient’s condition.

Setting

This procedure is performed in a hospital, specifically in the intensive care unit (ICU) or an operating room equipped for ECMO.

Personnel

• Cardiothoracic surgeon or interventionalist
• Critical care physician
• ECMO specialist or perfusionist
• Anesthesiologist
• ICU nursing staff

Risks and Complications

• Bleeding
• Infection
• Blood clots
• Equipment failure
• Stroke or other neurological injuries
• Lung or heart damage

Benefits

• Improved oxygenation and carbon dioxide removal when conventional methods are insufficient.
• Provides time for the lungs or heart to heal or for other treatments to take effect.
• Can be a life-saving intervention for severe respiratory failure.

Recovery

• Continuous monitoring in the ICU.
• Gradual weaning off ECMO as the patient's condition improves.
• Follow-up diagnostics to assess recovery.
• Physical rehabilitation may be needed post-procedure.

Alternatives

• High-frequency oscillatory ventilation (HFOV)
• Conventional mechanical ventilation
• Use of nitric oxide or other adjunctive therapies
• Lung transplantation for end-stage lung disease

Each alternative has its own risks and benefits which should be discussed with a healthcare provider.

Patient Experience

During the procedure, the patient will be sedated to minimize discomfort. Post-procedure, the patient might experience some soreness at the cannula insertion sites. Pain management measures will be in place to ensure comfort. The patient will be monitored continuously, and any emerging issues will be addressed promptly.