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ECMO
Specialists at Ascension Saint Thomas Heart in Nashville, Tennessee, deliver advanced care for adults with heart failure using ECMO.
Care for heart and lung failure with ECMO
Specialists at Ascension Saint Thomas Heart in Nashville, Tennessee, deliver advanced care for adults with heart failure using ECMO.
Why choose us
The extra corporeal membrane oxygenation (ECMO) program and experienced care teams at Ascension Saint Thomas Heart provide advanced care for patients who have life-threatening lung and heart conditions, including severe heart and respiratory failure, and who are critically ill. Ascension Saint Thomas Heart is among the top 10% of ECMO programs worldwide by patient volume, which means our team has extensive experience and expertise in providing this advanced, life-saving care.
Understanding ECMO
This advanced technology is used to temporarily provide respiratory support and blood circulation– allowing your lungs and heart to rest while they are recovering from illness or injury. ECMO may also be used while you are waiting for a heart or lung transplant. This machine maintains blood flow and oxygen to vital organs, like the brain, kidneys and liver.
ECMO is used when:
- Your heart can’t pump blood to all the parts of your body
- Your lungs cannot provide enough oxygen to the body, even when given extra oxygen
- Your lungs cannot get rid of carbon dioxide, even with help from a mechanical ventilator
- You are waiting for a ventricular assist device (heart pump) or heart or lung transplant
A surgeon places one or more plastic tubes, called a cannula, into large blood vessels in your chest, neck or groin. The ECMO pump circulates your blood through the machine’s artificial lung or oxygenator. Carbon dioxide is removed from the blood and oxygen is added. As oxygenated blood leaves the oxygenator, it is warmed before returning to your body.
A member of your care team is with you 24/7 to monitor your machine and provide care. Your doctor uses blood tests, X-rays and other tests to make sure you are responding well to your treatment.
There are two types of ECMO support:
- Venoarterial ECMO (VA ECMO) is used when the heart and lungs need support. The blood leaves the body from a vein, receives oxygen and is returned through an artery. This allows your heart and lungs to rest and recover.
- Venovenous ECMO (VV ECMO) is used for lung support when the heart is still working well. The blood leaves the body from a vein, receives oxygen and is returned through the same vein or another vein. This allows the lungs to rest and recover.
Reasons you might need ECMO
Our ECMO-trained specialists deliver advanced care for complex heart and lung conditions, including:
Cardiac failure
- Cardiac arrest
- Cardiogenic shock following heart surgery
- Drug overdose
- Heart attack
- End-stage heart failure (as a bridge to heart transplant, LVAD, or total artificial heart)
- Ongoing life-threatening arrhythmias
- Myocarditis
- Sepsis or stress-induced heart failure
- Valvular disorders with cardiogenic shock
Respiratory failure
- Acute respiratory distress syndrome
- Bacterial or viral pneumonia
- Lung rupture (pneumothorax)
- Pulmonary embolism
- Status asthmaticus
Excellence in life support
Ascension Saint Thomas Hospital West received a Gold Level ELSO Award for Excellence in Life Support for providing high performing care for patients needing life saving support.
How to get care
Early consultation with the ECMO care team can help physicians know when to refer patients to an ECMO program. A transfer may be recommended for patients who have received appropriate medical management and meet criteria for ECMO.
Ascension Saint Thomas Heart has an ECMO transport team of nurses, perfusionists and paramedics who can transport patients from other medical centers to our comprehensive heart failure center for advanced care.
Refer your patient to Ascension Saint Thomas Heart
An ECMO transfer may be recommended for patients who have received appropriate medical management and meet one or more of the following:
Cardiac failure:
- Cardiac index <2.2 L/min/m2
- Evidence of end-organ hypoperfusion:
- Lactate > 2 mmol/L
- Low urine output
- Cool extremities
- Elevated liver enzymes
- Norepinephrine > 0.2 mcg/kg/min or equivalent
- Adding a 2nd vasopressor or inotrope
- SCAI Stage C or higher
Respiratory failure:
- Severe hypoxemia (PaO2 : FiO2 ratio <100) despite best practices including:
- PEEP ≥ 10 mmHg
- FiO2 ≥ 80%
- Prone positioning
- Neuromuscular blockade
- Severe air leak syndromes preventing optimal mechanical ventilation settings
- Inability to achieve lung-protective ventilation (plateau pressure <30)
- Hypercarbic respiratory failure (PaCO2 > 60 with pH < 7.25)
To transfer a patient, please call 1-888-ECMO-911.
If you are experiencing a life-threatening emergency, go directly to the ER or call 911.
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