Extracorporeal membrane oxygenation (ECMO) is a modified heart-lung machine that provides lung and/or heart support in patients with extreme organ dysfunction, refractory to conventional support strategies. It is a highly specialised service provided in specialist tertiary intensive care units, where clinicians with expertise in ECMO are available to support the initiation, ongoing management and post-ECMO patient care.
Types of ECMO
There are two main types of ECMO: venovenous and venoarterial.
Venovenous ECMO involves venous blood from the patient being accessed from the large central veins and returned to the venous system near the right atrium after it has passed through an oxygenator. It provides support for severe respiratory failure when no major cardiac dysfunction exists.
Venoarterial ECMO involves venous blood from the patient being accessed from the large central veins and returned to a major artery after it has passed through the oxygenator. It provides support for severe cardiac failure (sometimes with associated respiratory failure), most commonly after cardiac surgery.
Resources
Adult patients
- ECMO services in NSW – Adult patients: Clinical practice guide (PDF 989.0 KB)
The clinical practice guide outlines key areas of ECMO practice for adult patients in NSW: indications and patient selection, retrieval, initiation, maintenance, weaning, complications, use in extra corporeal pulmonary, resuscitation.
Published: November 2020. Next review: 2026. - ECMO services – Adult patients: Organisational model of care (PDF 3.9 MB)
The adult ECMO model of care is based on five core principles: structure and organisation, protocols and procedures, appropriate team composition, workforce education and training, and governance and leadership.
Published: November 2020. Next review: 2026.
Neonatal and paediatric patients
- ECMO retrieval services in NSW – Neonatal and paediatric patients: Evidence series rapid review (PDF 396.7 KB)
Drawing on experiential and research evidence, this report outlines the neonatal and paediatric ECMO retrieval services in NSW.
Published: November 2020. Next review: 2026. - ECMO retrieval services – Neonatal and paediatric patients: Organisational model of care (PDF 611.7 KB)
The organisational model of care for neonatal and paediatric ECMO retrievals focuses on eight key components: operationalising retrievals, communication and decision making, checklists and protocols, team composition, data and information, education and training, governance and patient, family and carer support.
Published: November 2020. Next review: 2026. - Minimum equipment requirements to support a paediatric ECMO retrieval service: Clinical practice guide (PDF 551.7 KB)
This guide outlines equipment components for an ECMO retrieval service: equipment components for a child requiring ECMO, additional equipment required from a referring hospital, a checklist for instruments and equipment, equipment for site cannulation.
Published: February 2022. Next review: 2026.