General, Research, Technology

What is ECMO and how is it different from mechanical ventilation?

The situation with the spread of a new coronavirusSARS-Cov-2 requires emergency measures. However, European and American healthcare systems cannot withstand a sharp influx of patients for whom connecting to a ventilator is vital. This is necessary to help the patient breathe, since coronavirus causes SARS, as a result of which the lung membranes are blocked and filled with fluid, after which death occurs. To prevent this, extracorporeal membrane oxygenation (ECMO) may be required. But what is ECMO and how is it different from mechanical ventilation?

Doctors during a surgery to prepare a patient for extracorporeal oxygenation

Content

  • 1 How does ECMO work?
  • 2 In what cases is the ECMO device used?
  • 3 How is ECMO different from mechanical ventilation?
  • 4 What are the risks of ECMO?

How does ECMO work?

The word extracorporeal itself means “outsidebody / body. ” In general, ECMO is a cardiopulmonary bypass system - the device pumps and oxygenates the patient’s blood outside his body. This procedure is carried out in cases where all other types of treatment have already been tried. When a person is connected to ECMO, blood is pumped to an artificial lung - an oxygen generator. Technically, an oxygenator is a device that saturates blood with oxygen and removes carbon dioxide. When the patient emerges from a critical condition, he is disconnected from ECMO.

In simple words if the ventilator pumps pure dry oxygen into the lungsand takes carbon dioxide from them, ECMO takes over all the functions of the lungs to saturate the blood with oxygen and remove carbon dioxide from them. Blood is drawn from the patient (through the veins), enters the ECMO apparatus, cleansed of carbon dioxide, saturated with oxygen and returned to the patient.

In what cases is the ECMO device used?

ECMO is required for patients with cardiacinsufficiency, pulmonary insufficiency and those who have recently undergone heart surgery. ECMO is also used to assess the condition of other organs, such as the kidneys or brain, before proceeding with heart or lung surgery. In addition, the device is used to support the body of patients who are waiting in line for a lung transplant - the extracorporeal oxygenation method helps maintain tissues well saturated with oxygen, which makes the patient the best candidate for transplantation.

Today, amid the pandemic of the new coronavirusSARS-CoV-2 (COVID-19), ECMO is required for a large number of patients. In China, extracorporeal oxygenation has significantly reduced mortality. But the difficulty lies in the fact that far from all countries carry out this procedure, in addition, the situation with the number of ECMO devices is the same as with the number of mechanical ventilation devices (IVL). Moreover, very often patients are connected immediately to ECMO and mechanical ventilation, as this helps to heal the main respiratory organ - the lungs.

Doctors in Wuhan, China, operate on a patient with a coronavirus

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How is ECMO different from mechanical ventilation?

According to UCSF Health, the extracorporeal methodoxygenation is different from mechanical ventilation. The fact is that ECMO acts directly on the blood without affecting the organs. Moreover, patients can be connected to the extracorporeal oxygenation apparatus for a long time. And immediately after connecting, a person does not need food, since all vitamins and nutrients are delivered intravenously through a catheter.

In more detail about how the Ventilation Unit (IVL) works, we wrote in our article.

Recall that ventilators are designed tofeeding a mixture of oxygen and compressed air into the lungs. Thanks to mechanical ventilation, the lungs are saturated with oxygen, and carbon dioxide is removed. Patients are connected through an endotracheal tube, which is inserted into the respiratory tract, but there is also a connection through a mask. Ventilators save many lives, but their number is very limited throughout the world, and the cost varies from 500,000 to 300,000,000 rubles.

There are dozens of times less ECMO devices than IVL devices. Yes, and the cost of ECMO is many times greater.

Another important difference between ECMO and mechanical ventilationis a surgical procedure that is most often performed in the patient’s room. The patient is given sedatives and painkillers, and anticoagulants are prescribed to minimize blood clotting. The surgeon and the operating team insert ECMO catheters into either the artery or veins. Then an x-ray is taken - this is necessary in order to make sure that the tubes are in the right place. After connecting to the device, power will be provided either intravenously or through the nasopharyngeal tube.

Patient connected to ECMO

Also during extracorporeal oxygenationcertain medications are given to patients, including: heparin to prevent blood clots; antibiotics to prevent infections; sedatives to minimize movement and improve sleep, etc. To disconnect the patient from the device and remove the tubes, you need a surgical procedure. Before termination of ECMO therapy, several tests are usually performed to confirm that the heart and lungs are ready for independent work. Then - this time in the operating room - the doctor makes small stitches to protect the place where the tube is connected. However, even if the patient is disconnected from ECMO, he may still need mechanical ventilation.

Do you think there will be enough ECMO and mechanical ventilation devices in the context of the coronavirus epidemic in Russia? Share your opinion in the comments to this article, as well as with the participants of our Telegram chat

What are the risks of ECMO?

Unfortunately, despite the high efficiency, the ECMO procedure really carries risks, including:

  • Bleeding due to medication to prevent blood clotting;
  • Infection at the points of attachment of the device;
  • Blood transfusion problems may occur;
  • Small clots or air bubbles form in the tube;
  • The likelihood of a stroke increases.

Let's hope that connecting to ECMO devicesand as few people as possible need mechanical ventilation, and the spread of the new coronavirus can be controlled by following all WHO recommendations. Be healthy and try to leave your home as little as possible.