33952 Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older (includes fluoroscopic guidance, when performed)

Name of the Procedure

Extracorporeal Membrane Oxygenation (ECMO)/Extracorporeal Life Support (ECLS); insertion of peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older (includes fluoroscopic guidance, when performed).

Summary

In layman's terms, ECMO is a life-support procedure that oxygenates the blood outside the body using a machine. This description covers the insertion of tubes (cannulas) into the blood vessels through the skin to support patients who are 6 years old and older.

Purpose

ECMO is used to treat severe heart or lung conditions by temporarily taking over the function of these organs. The goal is to provide the heart and lungs with time to heal or to serve as a bridge to further treatment, such as a transplant.

Indications

• Severe respiratory failure
• Severe cardiac failure
• Life-threatening situations where conventional treatments have failed
• Persistent life-threatening circulatory collapse

Preparation

• Fasting for a certain period before the procedure, typically 6-8 hours
• Adjustments or discontinuation of certain medications as directed by the physician
• Pre-procedure tests including blood work, imaging studies, and heart function tests

Procedure Description

1. Anesthesia: The patient is given local or general anesthesia to ensure comfort.
2. Insertion: Using fluoroscopic guidance, a physician inserts cannulas percutaneously (through the skin) into peripheral veins and/or arteries.
3. Positioning: The cannulas are positioned correctly to facilitate blood flow to and from the ECMO machine.
4. Connection: The cannulas are then connected to the ECMO machine, which will oxygenate and circulate the blood.

Duration

This procedure typically takes about 1-2 hours, depending on patient-specific factors.

Setting

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

Personnel

• Physician (e.g., cardiothoracic surgeon, critical care specialist)
• Nurses specialized in critical care
• Anesthesiologist or nurse anesthetist
• ECMO technician or perfusionist

Risks and Complications

Common risks include:

• Infection at the insertion site
• Bleeding
• Blood clots Rare risks:
• Damage to blood vessels
• Complications from anesthesia
• Mechanical failure of the ECMO machine

Benefits

• Immediate stabilization of heart and lung function
• Potential to reverse severe respiratory or cardiac failure
• Enhances recovery chances in critical conditions Benefits are typically realized immediately after the initiation of ECMO.

Recovery

• Continuous monitoring in the ICU
• Post-procedure care involves regular checks of cannula sites, blood tests, and imaging
• Recovery time varies depending on the underlying condition but can range from days to weeks
• Follow-up appointments to monitor heart and lung function

Alternatives

Other options may include:

• Mechanical ventilation
• Medications to support heart and lung function
• Heart or lung transplants Pros and cons of alternatives are primarily related to the severity and responsiveness of the underlying condition to conventional treatments.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Post-procedure, the patient may experience mild discomfort at the cannula insertion sites, which can be managed with pain medications. They might also experience tiredness and require assistance with activities as they recover.