33954 Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), open, 6 years and older

Name of the Procedure:

Extracorporeal Membrane Oxygenation (ECMO) / Extracorporeal Life Support (ECLS); Insertion of Peripheral (Arterial and/or Venous) Cannula(e), Open, 6 Years and Older

Summary

Extracorporeal membrane oxygenation (ECMO) is a life-support procedure that provides heart and lung support to patients whose organs are severely compromised. This procedure involves the insertion of tubes (cannulae) into peripheral blood vessels to deliver life-saving oxygen to the blood and remove carbon dioxide.

Purpose

ECMO is used to treat patients with severe heart or lung conditions that are not responding to conventional treatments. The primary goals are to improve oxygenation, remove carbon dioxide from the bloodstream, and provide time for the heart and lungs to heal.

Indications

• Severe respiratory failure
• Severe cardiac failure
• Conditions such as Acute Respiratory Distress Syndrome (ARDS) or life-threatening pneumonia
• Certain cases of cardiac arrest or trauma

Preparation

• Patients may be instructed to fast if time allows
• Adjustments to medications, especially blood thinners, may be necessary
• Pre-procedure diagnostics often include blood tests, echocardiograms, and imaging studies to assess the heart and lung function

Procedure Description

1. Anesthesia: The patient is given general anesthesia to ensure they are unconscious and pain-free.
2. Site Preparation: The skin is cleaned and sterilized over the intended vascular access points.
3. Insertion: A surgeon makes small incisions and inserts the cannulae into peripheral arteries and/or veins.
4. Connection to ECMO Machine: The cannulae are connected to the ECMO machine, which oxygenates and removes carbon dioxide from the blood.
5. Monitoring: Continuous monitoring of the patient’s vitals and blood parameters is maintained throughout the procedure.

Duration

The insertion typically takes about 1-2 hours.

Setting

This procedure is performed in a hospital setting, often in the intensive care unit (ICU) or a specialized cardiac operating room.

Personnel

• Cardiac Surgeon or Vascular Surgeon
• Anesthesiologist
• ECMO Specialist (Perfusionist)
• Critical Care Nurses and Support Staff

Risks and Complications

• Bleeding or clotting at the insertion site
• Infection
• Vascular injury
• Thrombosis (clot formation) or embolism (clot displacement)
• Organ failure if the support is prolonged

Benefits

• Provides vital support when heart or lung function is critically impaired
• Helps maintain adequate oxygen levels and remove carbon dioxide from the blood
• Allows the heart and lungs time to heal or be treated with other therapies

Recovery

• Close monitoring in the ICU
• Regular blood tests and chest X-rays to assess progress
• Physiotherapy and rehabilitation may be needed after ECMO is discontinued
• Expected recovery time varies depending on the underlying condition and the duration of ECMO

Alternatives

• Mechanical ventilation (for respiratory support)
• Pharmacological treatments such as vasopressors or inotropes
• Surgical interventions like heart surgery
• Each alternative carries its own risks and benefits, often considered based on specific patient factors

Patient Experience

• Patients are unconscious due to anesthesia during the procedure
• Post-procedure discomfort at cannulation sites is managed with pain medications
• The primary focus is on maintaining comfort and monitoring for any complications