Hi, I have a parent currently going through this and this is the one thing I really am a little bit confused on.
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Once the drugs that cause the paralysis of the heart wears off the heart will just start beating again. The nerves in the heart will send out heart beats on its own whenever they can. So there is no need to start the heart in any way as it starts on its own. The only issue which might arise with this is when the drug wears off in different parts of the heart at different times then the heart might not be synchronized. Part of the heart might beat out of phase with the rest so it is not effective at pumping blood. This is basically a fibrillation. In a healthy adult this situation will resolve itself after a bit of time. The ECMO machine will provide blood flow until the heart is working properly. But if the heart continue to fibrillate then the surgeons might need to use a defibrillator to essentially restart the heart making sure all parts of it is beating in phase. Once the surgeons are able to confirm that the heart is working properly they can start disconnecting the ECMO machine letting the blood flow through the heart as normal.
Once the drugs that cause the paralysis of the heart wears off the heart will just start beating again. The nerves in the heart will send out heart beats on its own whenever they can. So there is no need to start the heart in any way as it starts on its own. The only issue which might arise with this is when the drug wears off in different parts of the heart at different times then the heart might not be synchronized. Part of the heart might beat out of phase with the rest so it is not effective at pumping blood. This is basically a fibrillation. In a healthy adult this situation will resolve itself after a bit of time. The ECMO machine will provide blood flow until the heart is working properly. But if the heart continue to fibrillate then the surgeons might need to use a defibrillator to essentially restart the heart making sure all parts of it is beating in phase. Once the surgeons are able to confirm that the heart is working properly they can start disconnecting the ECMO machine letting the blood flow through the heart as normal.
It really depends on why you got put on ECMO in the first place.
First, there are two big classifications of ECMO: venovenous and venoarterial.
Venovenous means that blood is taken out of a central vein and put back into a central vein. This allows you to oxygenate the blood and sweep the carbon dioxide out of it, but does not provide any assistance to the heart. This is used for people who have a bad injury to their lungs, such as Covid or ARDS. In these cases, the hope is that as the lung heals the need for ECMO will decrease and eventually not be necessary anymore.
Venoarterial ECMO means that you take blood out of a central vein and put it back into the aorta. This allows you to oxygenate the blood, get rid of carbon dioxide, and also provide blood pressure support. This is typically used when there is something wrong with the heart, and the mode of recovery depends on what that problem was. If the problem was a heart attack that caused an abnormal heart rhythm (ventricular fibrillation or ventricular tachycardia) that we could not treat just with medications, then sometimes the heart will recover enough to support life in the days/weeks after the event. Usually it doesn’t beat as well as it did previously, but often enough to keep someone alive. If the problem was inflammation/infection of the heart muscle (myocarditis) or some other problem (such as peripartum cardiomyopathy) then sometimes the heart recovers enough to support life, and sometimes people need another exit strategy (such as an LVAD – a pump that assists the heart longer term) or a heart transplant. Sometimes people get put on ECMO because they had an overdose on a drug that poisons the heart (like a beta-blocker or calcium channel blocker) and often they recover spontaneously as their body metabolizes the drug.
All of that is to say it’s very complicated and highly dependent on why someone was put on ECMO in the first place, how old they are, and how they improve (or don’t) while on ECMO.
Finally, it’s unfortunate but many patients die despite ECMO, and that is important to recognize.
It really depends on why you got put on ECMO in the first place.
First, there are two big classifications of ECMO: venovenous and venoarterial.
Venovenous means that blood is taken out of a central vein and put back into a central vein. This allows you to oxygenate the blood and sweep the carbon dioxide out of it, but does not provide any assistance to the heart. This is used for people who have a bad injury to their lungs, such as Covid or ARDS. In these cases, the hope is that as the lung heals the need for ECMO will decrease and eventually not be necessary anymore.
Venoarterial ECMO means that you take blood out of a central vein and put it back into the aorta. This allows you to oxygenate the blood, get rid of carbon dioxide, and also provide blood pressure support. This is typically used when there is something wrong with the heart, and the mode of recovery depends on what that problem was. If the problem was a heart attack that caused an abnormal heart rhythm (ventricular fibrillation or ventricular tachycardia) that we could not treat just with medications, then sometimes the heart will recover enough to support life in the days/weeks after the event. Usually it doesn’t beat as well as it did previously, but often enough to keep someone alive. If the problem was inflammation/infection of the heart muscle (myocarditis) or some other problem (such as peripartum cardiomyopathy) then sometimes the heart recovers enough to support life, and sometimes people need another exit strategy (such as an LVAD – a pump that assists the heart longer term) or a heart transplant. Sometimes people get put on ECMO because they had an overdose on a drug that poisons the heart (like a beta-blocker or calcium channel blocker) and often they recover spontaneously as their body metabolizes the drug.
All of that is to say it’s very complicated and highly dependent on why someone was put on ECMO in the first place, how old they are, and how they improve (or don’t) while on ECMO.
Finally, it’s unfortunate but many patients die despite ECMO, and that is important to recognize.
Depends on if you’re referring to ECMO as longer-term like heart failure or lung disease vs. cardiac bypass during surgery. They’re the same but also different.
Long-term ECMO: Your heart never stops. You can set up ECMO to bypass the lungs or heart, rarely both. It depends on where the problem is. But in both cases the purpose is to reduce the workload and give the organs time to recover (heart failure, heart attack, heart trauma, asthma, ARDS, etc.). Once they’ve recovered you decrease the level of support and wean the person off of it.
Cardiac bypass during surgery: I’m not a surgeon so I don’t deal with this scenario, and can’t say the heart is stopped during 100% of surgeries. But when it is there are drugs used as well as electricity to shock the heart and get it going again, kind of like what you see in movies. In a worst-case scenario where it doesn’t want to keep going you insert wires to force it to beat, called pacer-wires which may or may not lead to insertion of a permanent pacemaker.
Depends on if you’re referring to ECMO as longer-term like heart failure or lung disease vs. cardiac bypass during surgery. They’re the same but also different.
Long-term ECMO: Your heart never stops. You can set up ECMO to bypass the lungs or heart, rarely both. It depends on where the problem is. But in both cases the purpose is to reduce the workload and give the organs time to recover (heart failure, heart attack, heart trauma, asthma, ARDS, etc.). Once they’ve recovered you decrease the level of support and wean the person off of it.
Cardiac bypass during surgery: I’m not a surgeon so I don’t deal with this scenario, and can’t say the heart is stopped during 100% of surgeries. But when it is there are drugs used as well as electricity to shock the heart and get it going again, kind of like what you see in movies. In a worst-case scenario where it doesn’t want to keep going you insert wires to force it to beat, called pacer-wires which may or may not lead to insertion of a permanent pacemaker.
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