33955 Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age

Name of the Procedure:

Extracorporeal membrane oxygenation (ECMO)/Extracorporeal life support (ECLS); insertion of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age

Summary

ECMO/ECLS is a medical procedure that provides prolonged cardiac and respiratory support to young children whose heart and lungs are unable to sustain life on their own. The procedure involves inserting tubes (cannulas) into large blood vessels through an incision in the chest, either by opening the sternum (sternotomy) or the side of the chest (thoracotomy).

Purpose

• Medical Condition: Severe cardiac or respiratory failure where conventional treatments are insufficient.
• Goals/Outcomes: To stabilize and support the child's heart and lung function, giving the organs time to heal or until alternative treatments are effective.

Indications

• Conditions like severe pneumonia, congenital heart defects, or cardiac arrest.
• Children from birth to 5 years old presenting with life-threatening heart and lung failure unresponsive to other treatments.

Preparation

• Pre-procedure Instructions: Patients may need to fast for several hours. Medication adjustments, such as stopping anticoagulants, might be necessary.
• Diagnostic Tests: Blood tests, imaging studies (like X-rays or echocardiograms), and possibly cardiac catheterization.

Procedure Description

1. The child is given general anesthesia to ensure they are asleep and pain-free.
2. The surgeon makes an incision either at the sternum (sternotomy) or the side of the chest (thoracotomy).
3. Cannulas are carefully inserted into the central blood vessels to direct blood out of the body into the ECMO machine, where it is oxygenated and cleared of carbon dioxide.
4. The oxygenated blood is then pumped back into the body, bypassing the heart and lung functions temporarily.
5. The incisions are closed, and the child is closely monitored.

Tools/Equipment:

• ECMO machine, cannulas, surgical instruments, monitoring devices.

Duration

The procedure typically takes several hours.

Setting

Performed in a specialized operating room within a hospital, often in a pediatric or cardiothoracic surgery unit.

Personnel

• Pediatric surgeon or cardiothoracic surgeon.
• Anesthesiologist.
• Perfusionist (specialist running the ECMO machine).
• Surgical nurses and technicians.
• Pediatric intensivist.

Risks and Complications

• Common Risks: Bleeding, infection, blood clots.
• Rare Risks: Organ damage, neurological damage, reaction to anesthesia.

Benefits

• Provides immediate and temporary life support for critical heart and lung conditions, potentially life-saving.
• Allows time for the child's organs to heal or for other treatments to be effective.

Recovery

• Post-Procedure Care: Continuous monitoring in an intensive care unit (ICU), pain management, and gradual weaning from ECMO support.
• Recovery Time: Can vary based on the underlying conditions, ranging from days to several weeks. Follow-up appointments are necessary.

Alternatives

• Other Treatments: Conventional mechanical ventilation, medications to support heart function, or surgery to correct underlying issues.
• Pros and Cons: ECMO is usually considered when other treatments fail, making it a critical but more invasive option.

Patient Experience

• The child will feel no pain during the procedure due to anesthesia. Post-procedurally, they may experience discomfort at the incision site and require pain management.
• Supportive care from a multidisciplinary team ensures their comfort and continuous monitoring.