When will my child be ready to come off ECMO?
Your child will come off ECMO support when all the doctors involved agree that your child is ready and that the lungs and/or heart have recovered enough. They do this by looking at your child’s progress daily to see if there has been enough improvement or if more time is needed. In rare cases, it is necessary to come off ECMO early due to complications like clotting or bleeding. We will discuss this with you fully should it be the case.
Child on ECMO for respiratory reasons (VV ECMO)
There are four ways to check if the lungs have improved:
- an x-ray to look at the appearance of the lungs
- blood gases to see if there is improvement in oxygen and carbon dioxide level
- bronchoscopy (a flexible telescope that goes down the breathing tube to look at the lungs
- CT scan of the chest
The doctors will assess some or all of these before making a decision.
Coming off ECMO:
The ECMO flow is decreased slowly as the oxygen and carbon dioxide levels improve. This can take several days or weeks. When the
ECMO flow has decreased to a certain point, the gas supply to the artificial lung is discontinued. This means that the child’s
lungs are now doing all the work. If the blood gases remain good with satisfactory oxygen and carbon dioxide levels, then the child
may be ready to come off ECMO.
Child on ECMO because of poor heart function (VA ECMO)
There are several ways to check if the heart has improved:
- blood pressure should be normal without increasing medications
- an echocardiogram will show how well the heart is beating
- blood gases and x-rays are also helpful
The doctors will look at all of these things before making a decision.
Coming off ECMO:
The ECMO flows are slowly reduced to the minimum safe level to prevent clotting. When the child is ready, there will be a “trial off”. This involves clamping the tubing near the cannulae so that the blood in the circuit circulates through the bridge. At this time the child’s
heart is doing all the work. If the blood pressure and blood gases remain satisfactory ECMO is no longer needed. It is not
uncommon for a child to have problems during the trial off. If this happens the clamps are removed and the circuit will
provide support again. Usually, after a day or two more of recovery time, there will be another trial off.