ECMO Therapy for Babies and Children – All You Need to Know
Children requiring ECMO suffer from congenital diaphragmatic hernias, sepsis, respiratory distress syndrome, pneumonia, and persistent pulmonary hypertension. ECMO therapy may be helpful for children who have pneumonia, sepsis, acute respiratory distress syndrome, or specific heart abnormalities. The particular issues your infant or child has will be covered in conversation with you by your child’s doctor. ECMO is given only to children whose lung and cardiac condition is reversible.
An artificial lung is part of the ECMO (extracorporeal membrane oxygenation) procedure. It helps pump blood back into a critically unwell infant’s bloodstream. Outside of the baby’s body, this system offers heart-lung bypass support. A child expecting a heart or lung transplant might benefit from it. The heart-lung bypass machine used during open heart surgery and the ECMO machine is similar. When your child is put on ECMO, an artificial lung in the ECMO circuit supplies oxygen to your child’s blood. Your child’s blood will receive the oxygen it needs to survive thanks to the artificial lung in the ECMO network until its heart and lungs can beat independently.
How Does ECMO Help?
Children and newborns can benefit from ECMO for several illnesses and diseases, such as:
- Intensive Pneumonia (H1N1 or other viral and bacterial pneumonia).
- Children with a lung illness known as acute respiratory distress syndrome (ARDS) have trouble breathing independently.
- Congenital heart abnormalities (Congenital disabilities in the heart).
- End-stage respiratory or heart failure (as a bridge to transplant).
- Sepsis (Severe infection in the bloodstream).
There are two types of ECMO therapy.
- Veno-venous ECMO (VV): It is used when the heart is beating, but the lungs need to take a break and recover. A large vein’s blood is drawn, treated with oxygen and carbon dioxide removal, and then returned to the vein. The vein allows the blood to flow to the heart. The blood is then circulated through the body and lungs by the heart.
- Veno-arterial ECMO (VA): It is employed when the heart and lungs require rest and recuperate. It draws blood from a big vein, oxygenates it, and then draws out carbon dioxide. The blood returns to an artery. The artery allows the blood to leave the body. The heart keeps beating and continues to send blood to the body. However, it can exert less effort than it did before ECMO.
Placing a Baby on ECMO
The newborn must be stabilized before starting ECMO, and the ECMO pump must be carefully set up and primed with fluid and blood. Catheters are inserted into the baby’s neck or groin’s big blood vessels during surgery to connect the ECMO machine to the infant.
A catheter inserted in a big vein will allow the patient’s dark blood (low in oxygen) to drain naturally from them. The mechanical heart-like pump will circulate blood through the remainder of the ECMO system. The blood is pumped into the oxygenator, which removes carbon dioxide and provides oxygen. After leaving the oxygenator, the blood is warmed before being delivered to the patient via the arterial catheter. The color of this oxygenated blood will be bright red. Your child’s body won’t be aware that anything is happening because the blood is taken out and reinjected into the kid at the same rate.
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Duration of ECMO
The duration of ECMO therapy varies on a child’s health conditions. For example, a child may use ECMO for as little as a day or a month.
What to Expect after ECMO?
Your child will require continued ventilator support to ensure oxygenation after removing the cannulas and ECMO circuit. A gas called nitric oxide is administered via the ventilator to relax blood arteries. The objective is gradually weaning your child off the ventilator and drugs over time. A nurse will continue to regularly check the vital signs and do lab tests as required. Although every child is unique, be ready for your child’s ECMO recovery time to be assessed in weeks and months instead of days.
Risk Factors of ECMO
Significant concerns come with ECMO. Doctors use it after exhausting all other options and are confident that ECMO would be helpful. Among the dangers are the following:
- Blood clots or bubbles that could obstruct blood arteries
- Issues with the ECMO device
Additionally, ECMO may have some unfavorable effects, like swelling (edema), which is particularly prevalent in the first few days. Typically, by the time ECMO is complete, the edema has subsided.
ECMO specialists work with your child on a day-to-day basis during ECMO therapy. A team of highly trained doctors or perfusionists with past expertise in intensive care units is known as the ECMO Specialists. They can handle ECMO patients and ECMO devices thanks to specialized training. If required, speak to parents of children who have had ECMO therapy to assuage your concerns.
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