Paediatric ECMO (Extracorporeal Membrane Oxygenation)

Specialised multidisciplinary teams lead the delivery of ECMO, an advanced life-support system for children with refractory cardiac or pulmonary failure. This intervention provides a temporary bypass, allowing organs to recover from reversible conditions when standard intensive care fails. It is not a first-line therapy, but it is crucial for patients with limited options. 

ECMO has significantly improved survival by offering a specialised bridge to recovery during severe, life-threatening illnesses. When mechanical ventilation and vasoactive medications are insufficient, this system provides the necessary time and support for healing, transforming the prognosis for many of the most critically ill.

Extracorporeal Membrane Oxygenation (ECMO) is an advanced mechanical support system that helps children whose hearts or lungs have reached the limits of their functional capacity. It serves as an external bypass to sustain life during acute crises.

In children, ECMO is used when:

• The lungs cannot oxygenate the blood sufficiently

• The heart cannot pump blood throughout the body

• Both organs are failing simultaneously

The process involves drawing blood through a cannula into a specialised machine. This device adds oxygen, eliminates carbon dioxide, and returns the blood to the child. This mechanical assistance allows the natural organs to remain dormant while the patient undergoes intensive treatment.

There are two main types of Paediatric ECMO:

• Veno-Venous (VV) ECMO – Supports only the patient’s breathing

• Veno-Arterial (VA) ECMO – Supports both heart and lung mechanics

This technology does not fix the illness. It creates a window for clinical recovery or for surgeons to perform life-saving operations.

Paediatric ECMO is an advanced support system for children when standard therapies fail. It is intended for severe, reversible organ failure. The system is considered during:

• Severe pneumonia or ARDS

• Viral infections impairing the lungs

• Congenital heart defects or myocarditis

• Septic shock affecting the heart

• Adverse outcomes following heart surgery

• Cardiac arrest requiring prolonged CPR

• Newborn meconium aspiration

• Persistent pulmonary hypertension (PPHN)

ECMO also provides a bridge to cardiac surgery, lung healing, or heart transplantation. As this intervention carries significant medical risks, it is only performed when the potential for survival outweighs the risk of complications.

Not every critically ill child is eligible for ECMO. Decision-making involves high-level consultation between paediatric intensivists, cardiologists, and surgeons to ensure clinical appropriateness for this advanced life support.

Suitable candidates for ECMO include:

• Severe, reversible respiratory failure

• Acute myocardial dysfunction with recovery capacity

• Patients refractory to maximal ventilation and drugs

• Neonates with life-threatening lung conditions

• Post-arrest patients with high neurological recovery potential

Pre-procedural assessment focuses on the following:

• Pathological diagnosis

• Chronicity of the illness

• Therapeutic resistance

• Secondary organ status

• Probability of long-term survival

The primary aim is to identify patients most likely to benefit from temporary mechanical cardiopulmonary assistance.

Although ECMO can be life-saving, it may not be appropriate in certain situations.

Doctors may avoid or reconsider ECMO if:

• There is an irreversible brain injury

• The child has a terminal condition with no chance of recovery

• Severe bleeding disorders are present

• There is advanced, irreversible multi-organ failure

• The child has been on high ventilator support for an extended period without improvement

Each case is evaluated individually. The medical team discusses risks, expected outcomes, and alternatives with the family before proceeding.

Paediatric ECMO is performed in a specialised intensive care unit (ICU) by a trained ECMO team that includes paediatric intensivists, cardiac surgeons, perfusionists, nurses, and respiratory therapists. Before starting ECMO, the team explains the procedure, potential risks, and expected course of treatment to the child’s caregivers.

Before initiating ECMO:

• A detailed medical evaluation is conducted

• Blood tests and imaging studies are reviewed

• Consent is obtained from parents or guardians

• The child is usually sedated and placed on a ventilator

In emergency situations, ECMO may be initiated urgently to stabilise the child.

ECMO cannulation is usually done in the ICU or an operating room while the child is sedated and pain-free.

The procedure entails:

• Inserting cannulas into large neck or chest vessels

• Drawing blood through the machine for oxygenation

• Returning oxygenated blood to the child

Management during support:

• Non-stop monitoring of heart rate and blood pressure

• Frequent testing of blood clotting levels

• Adjusting drugs to maintain stability

• Resting the lungs by lowering ventilator settings

The duration of ECMO is flexible. Recovery may take days or weeks, depending on the specific illness treated and the patient's observed response to the life-support therapy.

When signs of improvement appear, doctors reduce ECMO support. Heart and lung capacity are tested for independence before removing the tubes. Close ICU monitoring continues post-removal. Recovery usually involves:

• Continued ventilator assistance

• Physical rehabilitation

• Cardiac or respiratory follow-up

While some children achieve a full recovery, others may need ongoing medical care depending on the severity of the initial condition.

ECMO is a complex medical procedure carrying specific risks. Intensive monitoring is used to identify and manage any complications early.

Recognised risks:

• Bleeding, primarily from blood thinners

• Clots in the circuit

• Infection

• Stroke

• Renal failure

• Machine failure

• Neurological issues

ECMO has significantly enhanced survival for carefully selected children. The medical team is responsible for evaluating the balance between patient risk and clinical benefit throughout the treatment process.

ECMO’s primary purpose is to deliver life-saving support when standard intensive care cannot maintain stability.

Paediatric ECMO is intended to:

• Supply oxygen to the brain and vital organs

• Support the heart as it recovers function

• Halt the progression of organ damage

• Provide a window for medical treatment of infections

• Bridge the patient to surgical or transplant outcomes

• Improve survival in severe lung or heart failure

By resting the heart and lungs, ECMO creates a critical window for patient recovery.

Paediatric ECMO is a specialised life-support system that requires advanced infrastructure and an expert, multidisciplinary team. Gleneagles Hospitals provide this support through comprehensive paediatric critical care. Facilities include:

• Dedicated PICU and NICU departments

• Specialist teams of intensivists, surgeons, and nurses

• Continuous 24/7 monitoring and critical care

• Customised circuits for paediatric and neonatal patients

• Integrated cardiology, surgery, and respiratory expertise

• On-site laboratory and imaging for constant assessment

ECMO initiation follows a meticulous evaluation of the patient’s clinical status. Families are provided with comprehensive counselling on the procedure and possible risks before treatment begins.

Paediatric ECMO provides advanced life support for children with severe heart or lung failure when conventional treatments fail. It does not offer a direct cure but facilitates a period of rest for recovery or further medical action. While the therapy is not without risk, it remains an essential component of paediatric critical care. Success is contingent upon careful patient selection, continuous monitoring, and a highly experienced medical team. For families managing a child’s critical illness, ECMO offers a specialised and potentially life-saving intervention when deployed within the correct clinical and medical framework.