How is someone placed on ECMO?

As a parent, it's helpful to understand that ECMO tubes (called cannulas) can be placed in different spots on your child's body, depending on their age, size, specific condition, and what's safest at the time. The doctor picks the best approach to give reliable support while minimizing risks.

There are two main types of ECMO your child might need:

1. Veno-Arterial (VA) ECMO – This helps both the heart and lungs. It's used when the heart is struggling (for example, in severe heart issues or when lung problems add extra strain on the heart).

• Doctors place two cannulas: one to drain blood from a large vein (often the right atrium or a big vein leading to it), and one to return oxygen-rich blood to a large artery (like the aorta or another major artery).
• This lets the machine take over pumping and oxygenating the blood, so your child's heart and lungs can rest.

2. Veno-Venous (VV) ECMO – This helps only the lungs (when the heart is strong enough on its own). It's often used for severe breathing problems, like bad pneumonia, lung injury, or conditions like congenital diaphragmatic hernia.

• Usually, one special dual-lumen cannula (a single tube with separate channels for draining and returning blood) is used, or sometimes two separate venous cannulas.
• Blood is pulled from a large vein, oxygenated in the machine, and returned to another vein (often near the heart). Your child's own heart keeps pumping this better-oxygenated blood around the body.

Common cannulation sites (where the tubes go in):

• Neck (cervical): Very common in newborns and small children. Tubes go through the right side of the neck into large vessels close to the heart (internal jugular vein for drainage; carotid artery for return in VA). It's often preferred for babies because it's direct and effective.
• Femoral (groin area): More common in older children, bigger kids, or teens. Tubes go into the femoral vein (and artery for VA) in the upper thigh. This avoids the neck and is useful if neck vessels aren't suitable or are already used.
• Central: Tubes are placed directly into the heart or major chest vessels (like the right atrium for drainage and aorta for return in VA). This happens during open-chest surgery (sternotomy), often right after heart surgery or if other sites aren't working well. It provides very strong, reliable flow but is more invasive.

The team chooses the site based on your child's needs—sometimes they start with one and switch later if necessary. Placement is done carefully (often with ultrasound or in the OR) under anesthesia or sedation.

What happens during setup? While the doctors place the cannulas, a specially trained perfusionist (an expert who runs heart-lung machines) prepares the ECMO circuit and gets it ready for safe use.

ECMO isn't a cure, it's a bridge that buys precious time (days to weeks) for medicines, healing, or surgery to fix the underlying problem. At Driscoll Children's Hospital a dedicated team monitors your child 24/7 to keep everything stable and safe.