Extracorporeal Membrane Oxygenation (ECMO)

Extracorporeal Membrane Oxygenation (ECMO) is a highly specialized form of emergency life support used when the heart or lungs are too weak to function on their own. It temporarily takes over the job of circulating blood and managing oxygen and carbon dioxide levels, giving the body time to heal.

ECMO is typically used in intensive care settings for patients with severe heart or lung failure. It can serve as a bridge to recovery, organ transplant, or other advanced therapies.

ECMO uses a machine outside the body to perform the work of the heart and lungs. Depending on the patient’s needs, ECMO can support Lung function only with Venovenous (VV) ECMO, or both heart and lung function through Venoarterial (VA) ECMO.

During ECMO, doctors place one or two flexible tubes (called cannulas) into large veins—and sometimes an artery. These tubes connect to the ECMO circuit: a pump that moves blood, a “membrane oxygenator” that acts like an artificial lung to add oxygen and remove carbon dioxide, and a warmer to bring blood back to body temperature. Monitors track flow, pressures, and oxygen levels so the team can adjust the settings in real time. Blood returns to the body through the tubing, and medicines prevent clotting and support comfort. As the heart and lungs recover, the team slowly reduces ECMO support and removes the cannulas.

ECMO Process:

1. Cannulas placed in a large vein (and sometimes an artery).
2. The pump draws blood out to the ECMO machine.
3. The membrane oxygenator adds oxygen and removes carbon dioxide.
4. The blood is warmed and continuously monitored.
5. The blood returns to the body:
     • VV ECMO (vein to vein): supports lungs only.
     • VA ECMO (vein to artery): supports heart and lungs.
6. As organs improve, support is gradually reduced (“weaning”) and the tubes are removed (“decannulation”).

ECMO care happens in the ICU with 24/7 monitoring by a specialized team. As the patient, you may be sedated or awake and able to communicate or work with therapists. In the room, there will be an ECMO machine, monitors, and IV pumps; alarms are normal and help the team respond quickly.

• Care and comfort: Medicines manage pain/anxiety and prevent clots. Lines and tubes deliver treatments; mild bruising or bleeding can occur and is closely watched.
• Breathing and activity: You may have a ventilator or oxygen. When safe, therapists help you sit up, stand, or take short walks.
• Nutrition and routine: IV fluids and tube feeding are common until eating is safe. Daily checks, labs, and imaging guide the plan.

Family members can offer comfort and support by:

• Talking to or reading to the patient
• Playing music or sharing familiar sounds
• Bringing photos or personal items
• Participating in care discussions with the medical team

In some cases, ECMO may help clarify a diagnosis or provide time for important decisions about ongoing care.

The duration of ECMO therapy varies. Some patients may need support for only a few hours or days, while others may remain on ECMO for several weeks. The care team regularly evaluates progress and begins weaning off ECMO once the heart and lungs show signs of recovery.

Adult ECMO is used for patients with life-threatening conditions that affect the heart, lungs, or both. These may include:

• Acute respiratory distress syndrome (ARDS)
• Severe pneumonia or influenza
• COVID-19-related lung failure
• Heart attack or cardiogenic shock
• Myocarditis or cardiomyopathy
• Pulmonary embolism
• Trauma involving the chest
• Post-surgical complications
• Patients awaiting heart or lung transplants

While ECMO can be life-saving, it carries potential risks, including:

• Bleeding, especially due to blood-thinning medications
• Infection at cannula sites or in the bloodstream
• Blood clots, which can lead to stroke or organ damage
• Mechanical failure of the ECMO system
• Reduced circulation in limbs, potentially causing tissue damage
• Kidney injury, which may require dialysis

At UC Health, these risks are carefully managed by the ICU team.

Outcomes after ECMO depend on the underlying condition, the patient’s overall health, and how early ECMO is initiated. Some patients recover fully, while others may experience long-term effects. ECMO is not a cure, but it can provide critical time for healing or further treatment.

UC Health’s ECMO program at UC Medical Center delivers advanced, around-the-clock heart–lung life support with a coordinated, multidisciplinary team—physicians, ECMO specialists, nurses, respiratory therapists, pharmacy, nutrition, and rehab—focused on stabilizing the sickest adults and giving organs time to recover.

Since 2014, the team has supported more than 550 patients with survival rates that meet national benchmarks and maintains ELSO Gold Center of Excellence status. As the region’s leader, UC Medical Center is the only hospital offering rapid-response eCPR and was the first to implement helicopter transport, extending ECMO access within a 200-mile radius.