What is an ECMO machine (ECMO)?
ECMO (ECMO) is the full name. Extracorporeal membrane oxygenation is a device used to increase oxygen levels and decrease carbon dioxide levels in the bloodstream from outside the body. For patients whose lungs and heart cannot adequately exchange gases under normal conditions In Thailand, ECMO machines are used in medical schools and major hospitals across the country. Chulalongkorn Hospital, the Thai Red Cross Society, has started to use the ECMO machine for the first time in the intensive care unit after cardiothoracic surgery (CVT ICU) since 2011. It was introduced in 2003 and was used for the first time in the pediatric intensive care unit (PICU) in the 2011. According to the report, the survival rate of neonatal lung and heart support was 70%. % Survival rate in children and adults is similar i.e. 40 -50% However, compared to patients without resuscitation by ECMO, patients are found to have a mortality rate of up to 90%.
What kind of patients need ECMO (ECMO)?
The characteristics of patients requiring ECMO (ECMO) are critically ill patients with severe heart failure and patients with severe respiratory failure. Or in some cases, both symptoms can be combined. There are three operating systems of ECMO:
1. Veno-arterial (VA) for severe heart failure or both pulmonary and cardiac.
The device draws blood from large veins, such as from the neck in young children. or legs in older children and adults AND through an artificial lung machine to increase oxygen and help exchange carbon dioxide in the upper or lower aorta
2. Venovenous (VV) for severe respiratory insufficiency
The machine will suck blood from large veins through an artificial lung. and again in the main veins
3. Arteriovenous For moderately severe cases of respiratory insufficiency
This will apply pressure from the arterial side without the use of an artificial lung traction machine.
However, the use of ECMO (ECMO) has limitations for some groups of patients with certain concomitant factors, such as patients with terminal cancer, patients who have been using mechanical ventilation for a long time. or patients with aortic rupture, etc.
It was also found that the use of ECMO (ECMO) also caused some side effects to patients, such as brain hemorrhage, leg ischemia. (in patients using Veno-Arterial ECMO system), hemolysis, sepsis, thrombocytopenia, etc., that doctors and nurses Patients should be closely monitored and supervised 24 hours a day.
Therefore, the use of ECMO to save the life of critically ill patients requires a joint decision between the physician and the patient’s relatives. assessing disease severity indications and risk factors In addition, ECMO is an advanced medical technology. they have a high cost AND it must be a multidisciplinary collaboration that requires specialized personnel.
References: Chulalongkorn Hospital, Thai Red Cross Society
