Extracorporeal membrane oxygenation (ECMO) is advanced life support that can temporarily take over the work of the heart and/or lungs so the body has time to heal. At Cape Fear Valley Health, a dedicated ECMO team provides 24/7 care using modern equipment and evidence-based protocols to support critically ill patients safely and effectively. Many families first ask, what is ECMO? In short, extracorporeal membrane oxygenation ECMO uses an external circuit and an ECMO machine to deliver life-sustaining oxygenation and circulation when the body needs time to recover.
 

Overview of ECMO

ECMO is a form of heart–lung support that circulates blood through an external circuit, adds oxygen, removes carbon dioxide, and returns the blood to the body. If you are wondering what is ECMO or how an ECMO machine works, think of it as temporary heart–lung assistance provided outside the body while the care team treats the underlying illness.

Core components include:

  • Cannulas: Flexible tubes placed into large blood vessels to draw blood out and return it after treatment.
  • Pump: A centrifugal pump that moves blood through the circuit at controlled flow rates.
  • Oxygenator: A membrane device that acts like an artificial lung, exchanging oxygen and carbon dioxide. These parts function together as the ECMO machine and circuit.

How ECMO differs from other life support:

  • Ventilators move air in and out of the lungs and depend on the lungs to exchange gases. ECMO can oxygenate blood and remove carbon dioxide even when the lungs are too injured to work well.
  • Dialysis filters waste and excess fluid when kidneys are failing; it does not support oxygenation or circulation. ECMO specifically supports gas exchange and, in some cases, heart function as part of ECMO support.

Who provides ECMO care: In our intensive care units, a specialized team may include critical care physicians, cardiothoracic surgeons, perfusionists, ECMO specialists, critical care nurses, respiratory therapists, pharmacists, physical and occupational therapists, and case managers. Family-centered communication and daily multidisciplinary rounds guide the care plan for each ECMO patient.
 

How ECMO Works

During extracorporeal membrane oxygenation (ECMO), blood is withdrawn through a venous cannula, propelled by the pump to the oxygenator for gas exchange, and then returned to the patient. The team adjusts pump flow, sweep gas (which controls carbon dioxide removal), and oxygen concentration to meet specific targets. Continuous monitoring helps keep both the ECMO patient and circuit stable.

Types of ECMO support:

  • Veno-venous (VV) ECMO: Blood is drained from a vein and returned to a vein. It supports lung function in severe respiratory failure while the heart continues to pump normally. Typical uses include severe pneumonia, ARDS, or trauma-related lung injury.
  • Veno-arterial (VA) ECMO: Blood is drained from a vein and returned to an artery. It supports both heart and lung function and may be used for cardiogenic shock, cardiac arrest, or after heart surgery.

Bedside management includes continuous vital sign monitoring, oxygenation and ventilation targets, frequent blood tests (such as arterial blood gases, hemoglobin, and lactate), anticoagulation monitoring, circuit checks for clot or air, ventilator adjustments using lung-protective settings, nutrition support, early mobility when appropriate, and careful skin and line care. These steps help ensure safe ECMO support with the ECMO machine and reduce complications.

Outcomes vary based on the condition being treated and the duration of support. Some people experience full recovery, while others may have ongoing lung or heart impairment. Neurologic risks include stroke or hypoxic brain injury and are monitored with frequent exams and imaging when needed. After recovery, many benefit from pulmonary or cardiac rehabilitation and neurocognitive support.

How we reduce risk at Cape Fear Valley: Protocol-driven anticoagulation with frequent labs, meticulous sterile technique for all line placements and dressing changes, routine circuit checks by trained ECMO specialists, pressure injury prevention, and early mobility when safe. These practices help keep the ECMO machine and circuit functioning optimally during ECMO support.
 

 

When ECMO Is Used

Common indications:

  • Respiratory failure: Severe ARDS, influenza, COVID-19 complications, aspiration, trauma, or inhalation injury when conventional ventilation is not enough.
  • Cardiac failure: Cardiogenic shock, myocarditis, massive heart attack, post-cardiotomy failure, or support during high-risk procedures.
  • Perioperative or bridge support: As a bridge to recovery, durable mechanical circulatory support, or transplant evaluation in select cases.

Extracorporeal membrane oxygenation ECMO can be used in adults, children, and newborns when the potential for recovery is reasonable and risks are acceptable. Selection is individualized based on the underlying illness, its severity, and other health conditions, and each ECMO patient is evaluated by a multidisciplinary team.

Starting ECMO is typically considered for refractory hypoxemia or hypercapnia despite maximal medical therapy, or for circulatory collapse not responsive to medications and devices. Stopping ECMO is considered when sustained improvement is shown during weaning trials, blood gases and hemodynamics remain stable on reduced support, or when transitioning to another therapy. If recovery is not achievable and goals of care change, withdrawal may be discussed carefully with the family and care team.
 

Preparing for ECMO

Before ECMO begins, the team discusses goals, benefits, and risks with the patient or family and obtains informed consent when possible. Preparation may include imaging to guide cannula placement, lab testing, and arranging transport to the ICU or operating room for cannulation. In emergencies, life-saving extracorporeal membrane oxygenation (ECMO) may start quickly with ongoing updates to the family.

During ECMO, families receive frequent updates from physicians, nurses, and ECMO specialists. Visiting follows ICU policies to protect safety and rest. Families are encouraged to designate a primary contact for consistent communication and to join care planning meetings. The bedside environment typically includes monitors, a ventilator (as needed), and the ECMO machine and circuit; alarms and safety checks are part of routine care for every ECMO patient.

Recovery planning starts early. After decannulation (removing the ECMO cannulas), many patients need rehabilitation to rebuild strength and improve lung or heart endurance. The team arranges follow-up appointments, medication management, recommended vaccinations, and referrals to pulmonary or cardiac rehab, as well as behavioral health or social work support when needed.