33948 Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; daily management, each day, veno-venous

Name of the Procedure:

Extracorporeal Membrane Oxygenation (ECMO) / Extracorporeal Life Support (ECLS), Veno-Venous

Summary

Extracorporeal Membrane Oxygenation (ECMO) is a medical procedure where a machine takes over the work of the lungs by providing oxygen to the blood and removing carbon dioxide. Veno-venous ECMO specifically assists with lung function without aiding the heart.

Purpose

ECMO is used for patients with severe lung conditions that prevent the lungs from adequately oxygenating the blood. The goal is to give the lungs time to rest and heal while ensuring the body receives sufficient oxygen.

Indications

• Severe pneumonia
• Acute Respiratory Distress Syndrome (ARDS)
• Post-lung transplant complications
• Other severe respiratory failures Patients typically require ECMO when conventional treatments are ineffective.

Preparation

• Fasting may be required if general anesthesia will be used.
• Medication adjustments may be necessary, especially with blood thinners.

• Diagnostic tests such as blood gases, chest X-rays, and echocardiograms will be performed.

  Procedure Description

  1. Insertion of Cannulas: Large tubes (cannulas) are inserted into large veins in the patient's neck, chest, or groin.
  2. Connection to ECMO Machine: The tubes are connected to the ECMO machine, which pumps blood out of the body, oxygenates it, and removes carbon dioxide before returning it to the body.
  3. Monitoring and Adjustment: The ECMO machine's settings are constantly adjusted to ensure optimal support. Advanced technology and imaging tools guide accurate cannula placement. The procedure usually involves sedation or general anesthesia.

Duration

The initial setup of ECMO can take several hours. Patients can remain on ECMO for days to weeks, depending on their condition.

Setting

ECMO is performed in an Intensive Care Unit (ICU) of a hospital where continuous monitoring is possible.

Personnel

• Critical Care Physicians
• Cardiothoracic Surgeons
• ECMO Specialists (Perfusionists)
• ICU Nurses
• Anesthesiologists

Risks and Complications

• Bleeding due to anticoagulation
• Infection at cannulation sites
• Blood clots
• Mechanical failure of the ECMO machine
• Organ failure

Benefits

ECMO can provide life-saving support when other treatments fail. It allows the lungs to heal by maintaining oxygenation and carbon dioxide removal.

Recovery

• Continuous monitoring and support in the ICU.
• Gradual weaning off the ECMO machine as lung function improves.
• Detailed follow-up testing to assess recovery.
• Physical activity restrictions initially, with gradual resumption as per medical guidance.

Alternatives

• Mechanical ventilation
• Non-invasive ventilation (e.g., CPAP, BiPAP)
• Conservative oxygen therapy

Each alternative has varying degrees of effectiveness and risks, and their suitability depends on the patient's specific condition.

Patient Experience

• Sedation ensures the patient remains comfortable and unaware during the procedure.
• Minimal pain is expected due to pain management measures.

After the procedure, discomfort from cannulation sites and general fatigue can occur. Pain management strategies and supportive care are provided to ensure comfort during recovery.