Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; daily management, each day, veno-arterial
CPT4 code
Name of the Procedure:
Extracorporeal Membrane Oxygenation (ECMO) / Extracorporeal Life Support (ECLS); Daily Management, Each Day, Veno-Arterial (VA-ECMO)
Summary
Extracorporeal Membrane Oxygenation (ECMO) is a specialized life-support technique that provides prolonged cardiac and respiratory support to individuals whose heart and lungs are severely damaged. This method involves diverting blood from the body to an oxygenator that removes carbon dioxide and adds oxygen, and then returning it to the body.
Purpose
The procedure addresses severe cardiac and/or respiratory failure that is not responsive to conventional treatments. The goal is to stabilize the patient's vital functions to allow time for the heart and lungs to heal or for other treatments to take effect.
Indications
- Severe cardiac failure (e.g., cardiogenic shock, severe myocarditis).
- Acute respiratory distress syndrome (ARDS) with concurrent cardiac failure.
- Cardiac arrest where conventional resuscitation measures are insufficient.
Preparation
- Pre-procedure fasting as instructed by the healthcare provider.
- Medication adjustments, particularly anticoagulants.
- Diagnostic tests including ultrasound, blood tests, and imaging studies to evaluate cardiovascular and pulmonary status.
Procedure Description
- Preparation: The clinical team prepares by setting up the ECMO circuit, which includes cannulas, oxygenator, and pumps.
- Cannulation: Insert large cannulas into the patient's blood vessels, typically one in a vein to remove blood and another in an artery to return oxygenated blood.
- Initiating ECMO: Blood is drawn from the body, passed through the oxygenator where it is enriched with oxygen, then returned to the body via the arterial cannula.
- Monitoring and Management: Continuous monitoring of the ECMO circuit and the patient’s physiological parameters. Adjustments are made to ECMO settings and medications as required.
Equipment used includes ECMO machine, oxygenator, pumps, cannulas, and various monitoring devices. General or regional anesthesia is often used during cannula insertion.
Duration
ECMO can be managed daily for several days to weeks, depending on the patient's condition. Daily assessments and adjustments are necessary.
Setting
The procedure is performed in an intensive care unit (ICU) or a dedicated ECMO suite within a hospital.
Personnel
- ECMO Specialist/ Perfusionist
- Cardiothoracic Surgeon or Intensivist
- ICU Nurses
- Anesthesiologist
- Respiratory Therapist
Risks and Complications
- Bleeding and clotting issues due to anticoagulation
- Infection at cannula sites
- Mechanical failure of ECMO components
- Stroke or other thromboembolic events
- Additional complications related to prolonged ICU stay
Benefits
- Provides critical support to the heart and lungs, allowing time for recovery or other interventions.
- Can significantly improve survival rates in critically ill patients.
- Enhanced oxygenation and perfusion during periods of severe cardiac and/or respiratory compromise.
Recovery
- Ongoing intensive care and monitoring.
- Regular blood tests and imaging to monitor progress and potential complications.
- Tapering off ECMO support as the patient's condition stabilizes.
Alternatives
- Conventional mechanical ventilation for respiratory failure.
- Advanced cardiac support devices like Intra-Aortic Balloon Pump (IABP) or Ventricular Assist Devices (VADs).
- Medical therapy and less invasive surgical interventions. Each alternative must be weighed against the severity of the patient’s condition and potential outcomes.
Patient Experience
- Patients are usually sedated and may be unconscious for a significant duration of the ECMO support.
- Post-procedural discomfort from cannulation sites and potential sedation-related effects.
- Pain management strategies will be individualized to ensure patient comfort while on ECMO.