Hi, I have a parent currently going through this and this is the one thing I really am a little bit confused on.
In: 77
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.
Latest Answers