What care does my child receive while on ECMO?
• Routine monitoring
Vital signs including heart rate, blood pressure and temperature are checked.
All children are given heparin to prevent blood clotting.
Most are given medication to prevent movement.
Medication for sedation and pain relief are given as needed.
Other medication may be given to:
- help heart function
- improve urine output
- prevent infection
- treat an existing infection
• Kidney filter
In some children, when on ECMO, the kidneys do not work as well as they should. An extra filter is put into the circuit to remove fluids and waste products.
• Blood tests
We add heparin to the blood flowing through the circuit to stop it from clotting in the ECMO tubes. Clotting is when the blood turns into a jelly-like substance. During ECMO we want the blood to stay thin so it flows through the circuit easily. The nurse will check how long it takes for the blood to form a clot and will adjust the heparin to minimise the risk of bleeding. This is done at least once every hour and is called an ACT (Activated Clotting Time) test.
• Blood gases
Blood gases show us how much oxygen and carbon dioxide are in the blood. They are measured hourly at first but as your child’s condition becomes more stable we do not need to check them as often.
• Checking for signs of infection
We send specimens to the lab to check for signs of infection. Antibiotics are given when needed.
X-rays are taken every day to look for changes in the lungs. Babies will have a head ultrasound every day to check for bleeding into the brain. If your child’s condition is related to the heart, an echocardiogram, which is an ultrasound of the heart, will be done.
Most tests are done in the unit. However, sometimes, a test (such as a CT scan) must be done in another area of the hospital. Your child can be moved safely to that area while on ECMO.
• Routine care
Routine care stays the same after ECMO has begun.
- The ventilator will continue to breathe for your child (but at a lower pressure and rate, letting the lungs rest).
- The tube into your child’s lungs will be suctioned at intervals to keep them clear of secretions.
- Most children will be given special IV (intravenous) fluids to make sure they have all the protein, fat, vitamins and minerals they need.
- Some children may be fed using a tube passed through the mouth into the stomach.
• Blood transfusions
Blood transfusions may be necessary. Blood and platelet counts are checked frequently and other blood products are given as needed.
What are the risks of ECMO?