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What Is ECMO?

With the prevalence of COVID-19, more doctors are resorting to ECMO (Extracorporeal Membrane Oxygenation) to save lives as patients flood hospitals. ECMO is a complex form of life support used in critically ill patients with severe cardiac or respiratory failure. It provides temporary support for the heart and lungs, allowing them to rest and recover. But how exactly does it work? What are the advantages and disadvantages? Is it the best choice for COVID-19 treatment? This article will look into these questions and answer your doubts about this little-known approach.

How ECMO works

ECMO works by removing blood from the patient, oxygenating it outside the body using a machine, and then returning it to the patient. The machine consists of a pump, an oxygenator (artificial lung), and tubing. The blood circulates through the tubing and the oxygenator, where oxygen and carbon dioxide are exchanged. The oxygen-rich blood is then returned to the patient, helping to provide oxygenation and support for the heart and lungs.

There are two types of ECMO: veno-venous (V-V) ECMO, which supports the lungs only, and veno-arterial (V-A) ECMO, which supports both the heart and lungs. The application of ECMO typically takes several days to several weeks, depending on the patient's condition and progress.

History of ECMO

The concept of ECMO can date back to the 1950s when it was first used as a treatment for heart and lung failure in newborns. However, it wasn't until the 1970s that ECMO became a more widely used treatment, owing to the development of better oxygenators and other advances in medical technology. Here are some key milestones in the history of ECMO:

The 1950s: ECMO is first used as a treatment for heart and lung failure in newborns.

The 1970s: ECMO becomes a more widely used treatment following the development of better oxygenators and other advances in medical technology.

The 1980s: ECMO is used to support critically ill adults with severe heart and lung failure.

The 1990s: ECMO is increasingly used as a bridge to transplant for patients with end-stage heart and lung disease.

The 2000s: ECMO becomes a more widely available treatment as more medical centers establish ECMO programs.

The 2010s: ECMO becomes increasingly sophisticated and effective, with improved patient outcomes and reduced risks.

Today, ECMO is a widely recognized treatment for critically ill patients with severe heart or lung failure and is used in specialized medical centers around the world. While it remains a complex and challenging treatment, ECMO has helped to save many lives and has become a critical tool in the management of severe cardiac and respiratory failure.

Difference between ECMO and breathing machine

ECMO and a breathing machine, also known as a ventilator, are both forms of life support used in critically ill patients.
A breathing machine(ventilator), is a more traditional method that helps patients to breathe by delivering air into the lungs. The air pressure is adjusted to help the patient breathe in and out, and the machine also controls the amount of oxygen in the air being delivered to the patient. Ventilators are commonly used in patients with respiratory failure, including conditions such as pneumonia, acute respiratory distress syndrome (ARDS), and other lung diseases.

ECMO, on the other hand, is a more complex form of life support. Most importantly, it is less harmful than a breathing machine. Because when we breathe, the pressure in our lungs is negative, while breathing machines work by pressuring the oxygen into our lungs, which is opposite to how we breathe. For people in critical condition, this increase in positive pressure can cause lung injury. On contrary, ECMO works independently from your lungs, allowing them to rest and minimize the damage. Therefore, It is typically used in cases of severe cardiac or respiratory failure where a breathing machine alone is not enough to provide adequate support. Ultimately, the decision to use ECMO or a breathing machine depends on the patient's underlying condition, the severity of their symptoms, and other factors.

Advantages of ECMO

The advantages of ECMO can include:

Life-saving: ECMO can be life-saving for patients with severe cardiac or respiratory failure who might otherwise not survive.

Improved outcomes: ECMO has been shown to improve patient outcomes in some cases, particularly for patients with severe respiratory failure.

Bridge to transplant: ECMO can be used as a bridge to transplant for patients with end-stage heart or lung disease.

Minimal brain injury: ECMO can help to minimize brain injury by providing adequate oxygenation to the brain during a period of cardiac or respiratory failure.

Reduced risk of complications: ECMO can help to reduce the risk of complications associated with mechanical ventilation, such as barotrauma and ventilator-associated pneumonia.

Multiple organ support: ECMO can provide support for multiple organs in cases of severe cardiac or respiratory failure, including the heart, lungs, liver, and kidneys.

Disadvantages of ECMO

While ECMO has many advantages, it is after all a complex and invasive procedure, and there are risks associated with it, including bleeding, infection, and blood clots. Other disadvantages can include:

Cost: ECMO is a very expensive procedure, and the cost of ECMO can be a burden for some patients and their families.

Limited availability: ECMO is a highly specialized procedure that is typically performed in specialized medical centers by a team of experienced healthcare professionals, including cardiologists, intensivists, and perfusionists. Generally, ECMO is only available in specialized medical centers with experience in this procedure, and may not be accessible to many patients.

No guarantee of success: ECMO is not a guarantee of success, and there is no guarantee that a patient will recover fully or survive, even with ECMO support.

Long-term effects: There may be long-term effects associated with ECMO, such as damage to the blood vessels or other organs, although this is still being studied.

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