33956 Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of central cannula(e) by sternotomy or thoracotomy, 6 years and older

Name of the Procedure:

Extracorporeal Membrane Oxygenation (ECMO) / Extracorporeal Life Support (ECLS) - Insertion of Central Cannula(e) by Sternotomy or Thoracotomy, 6 Years and Older

Summary

Extracorporeal Membrane Oxygenation (ECMO) is a life-support procedure in which blood is oxygenated outside the body using a machine. This procedure involves inserting central cannulae through the chest (via sternotomy or thoracotomy) to provide circulatory and respiratory support for patients with severe heart and lung conditions.

Purpose

ECMO is used to support patients with severe cardiac or respiratory failure. The goal is to provide oxygen to the blood and remove carbon dioxide, allowing the heart and lungs to rest and heal.

Indications

• Severe respiratory failure (e.g., ARDS, pneumonia)
• Severe cardiac failure (e.g., cardiogenic shock, myocarditis)
• Failure to respond to conventional treatments
• Patients aged 6 years and older

Preparation

• Fasting for a certain period before the procedure (usually 8 hours)
• Pre-procedure tests: blood work, chest X-ray, echocardiogram
• Medications may need to be adjusted or stopped as advised

Procedure Description

1. Anesthesia: The patient is given general anesthesia.
2. Incision: A sternotomy (chest incision) or thoracotomy (incision between the ribs) is performed.
3. Cannulation: Central cannulae are inserted into large blood vessels.
4. Connection to ECMO: The cannulae are connected to the ECMO machine, which circulates and oxygenates the blood.
5. Monitoring and Adjustment: The patient's vital signs and ECMO parameters are closely monitored and adjusted as needed.

Tools and equipment include surgical instruments, ECMO machine, cannulae, and monitoring devices.

Duration

The procedure usually takes 2-4 hours.

Setting

The procedure is performed in a hospital, specifically in an operating room or a specialized ECMO center.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Perfusionist
• Critical care nurses
• Respiratory therapist

Risks and Complications

• Common risks: bleeding, infection, blood clots
• Rare risks: organ failure, stroke, complications from anesthesia Complications are managed through medications, additional procedures, or medical interventions.

Benefits

• Stabilizes and supports heart and lung function
• Improves oxygenation and removes carbon dioxide
• Provides time for the underlying condition to be treated or heal

Recovery

• Post-procedure care includes monitoring in the ICU.
• Recovery time varies; patients may need mechanical ventilation and other supportive measures.
• Follow-up appointments to monitor progress and adjust treatment.

Alternatives

• Mechanical ventilation: uses a machine to assist or replace spontaneous breathing
• LVAD (Left Ventricular Assist Device): supports heart function
• Pros and cons: ECMO provides both cardiac and respiratory support, whereas alternatives may support only one function.

Patient Experience

• During the procedure: Under anesthesia, the patient will not feel pain.
• After the procedure: Pain management will be provided. Patients may feel discomfort from the chest incision and cannulae.
• Comfort measures: Pain medications, sedation, and attentive care from the medical team will be provided.