33947 Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; initiation, veno-arterial

Name of the Procedure:

Extracorporeal Membrane Oxygenation (ECMO)/Extracorporeal Life Support (ECLS); Initiation, Veno-Arterial

Summary

Extracorporeal Membrane Oxygenation (ECMO) or Extracorporeal Life Support (ECLS) is an advanced medical procedure in which a machine takes over the work of the heart and lungs. This allows these organs to rest and heal while still providing vital oxygen and blood flow to the body. The veno-arterial approach involves diverting blood from a vein, oxygenating it outside the body, and then returning it to an artery.

Purpose

ECMO/ECLS is used to support patients with severe heart and/or lung failure that is unresponsive to conventional treatments. The primary goal is to stabilize the patient's condition, provide adequate oxygenation and circulation, and allow the heart and lungs time to recover.

Indications

• Severe respiratory failure unresponsive to mechanical ventilation
• Cardiogenic shock due to heart failure or severe heart attack
• Cardiac arrest with return of spontaneous circulation but ongoing circulatory collapse
• Post-operative support for high-risk cardiac surgery patients

Preparation

• Fasting for a certain period before the procedure may be required.
• Adjustments or cessation of specific medications (such as blood thinners).
• Pre-procedure diagnostic tests, including blood work, chest X-ray, ECG, and echocardiography.
• Consent forms and patient education on the procedure and its risks.

Procedure Description

1. Insertion of Cannulas: Sterile cannulas are inserted into large veins and arteries, typically in the neck or groin.
2. Connection to ECMO Machine: Blood is drawn from the venous cannula to the ECMO machine, where it is oxygenated and carbon dioxide is removed.
3. Reinfusion: The oxygenated blood is then returned to the arterial system.
4. Continuous Monitoring: Patients are monitored continuously for cardiac output, blood gases, and overall condition.
5. Support Equipment: Various pumps, oxygenators, and monitors are utilized.
6. Anesthesia: The procedure usually requires general anesthesia or sedation.

Duration

The initiation of ECMO/ECLS can take 1-2 hours. However, the duration on ECMO support varies significantly depending on the patient’s condition.

Setting

The procedure is performed in a hospital setting, often in an intensive care unit (ICU) or operating room (OR).

Personnel

• Cardiothoracic or vascular surgeons
• Critical care physicians
• Anesthesiologists
• ECMO specialists
• Nurses experienced in critical care

Risks and Complications

• Bleeding and blood clot formation
• Infection at the cannulation sites
• Stroke or other neurological complications
• Organ dysfunction due to complications from ECMO
• Mechanical failure of the ECMO equipment

Benefits

• Provides critical support to failing heart and lungs
• Allows time for underlying medical conditions to be treated and resolved
• Can be life-saving in otherwise refractory cardiac or respiratory failure cases

Recovery

• Close monitoring in the ICU
• Gradual weaning from ECMO support as the heart and lungs improve
• Post-procedure care includes wound care, physical therapy, and regular follow-up appointments
• The recovery period varies but can range from days to weeks depending on the patient’s response

Alternatives

• Mechanical ventilation and other forms of respiratory support
• Inotropes and vasopressors for cardiac support
• Surgical interventions like Left Ventricular Assist Devices (LVADs) or heart transplants
• Pros and cons: ECMO/ECLS offers more comprehensive support but comes with higher risks and resource requirements compared to conventional therapies.

Patient Experience

Patients might experience anxiety and discomfort from the intubation and immobilization. Pain management and sedation are provided to ensure comfort. Post-procedure, patients may feel fatigued and need rehabilitation to regain functional capacity.