ECMO stands for Extracorporeal Membrane Oxygenation. It is a life-support therapy that temporarily takes over the function of the heart and/or lungs when a patient's own heart and/or lungs are not working adequately. The technology is similar to the heart-lung bypass machine used during open-heart surgery.

How VA ECMO works 2 large catheters (tube) are placed in a patient’s Vein and Artery.

• A centrifugal pump in the ECMO circuit creates negative pressure to gently pull blood out of the patient’s Vein
• The blood flows into the ECMO circuit, where:
  • A membrane oxygenator (artificial lung) adds oxygen and removes carbon dioxide.
  • A heat exchanger warms the blood to maintain normal body temperature.
• The now oxygen-rich blood is returned to the body through another large catheter placed in a major Artery, either the aorta, right internal carotid artery, or femoral artery.

This process bypasses the heart and lungs, giving them time to rest and recover while providing essential circulation and oxygenation.

ECMO is most commonly used in critical care settings, such as neonatal or pediatric intensive care units, for conditions like severe respiratory failure, heart failure, or during recovery from certain surgeries. It requires close monitoring by a specialized team.

How VV ECMO works.

VV ECMO stands for Veno-Venous Extracorporeal Membrane Oxygenation. It is a life-support therapy that temporarily takes over lung function (oxygenation and carbon dioxide removal) when a patient's lungs are severely failing, but the heart is pumping adequately on its own.

Unlike VA (venoarterial) ECMO, which supports both heart and lungs, VV ECMO is primarily a respiratory support strategy. It is often preferred in pediatric and neonatal cases of isolated severe lung failure (e.g., refractory hypoxemia from conditions like meconium aspiration syndrome, pneumonia, or ARDS).

How VV ECMO works (typical configuration in children/neonates):

• One or more large catheters (cannulas) are placed in major veins (commonly the right internal jugular vein and sometimes femoral veins.
• A centrifugal pump in the ECMO circuit creates negative pressure to gently pull deoxygenated blood out of the patient.
• The blood flows through the ECMO circuit, where:
  • A membrane oxygenator (artificial lung) adds oxygen and removes carbon dioxide.
  • A heat exchanger warms the blood to maintain normal body temperature.
• Now oxygen-rich blood is returned to the patient's venous system (often back into a large vein, such as the right atrium via the same or a separate cannula).

This process allows oxygenated blood to mix with the patient's venous return, improving overall systemic oxygenation while allowing the damaged lungs to rest and recover. The heart continues to pump this oxygenated blood to the body.

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.

ECMO is designed to support lung and heart function when your child's lung and/or heart function is inadequate. ECMO does not cure lung disease; it merely supports your child to allow time for the lungs and/or heart to rest.

As a parent, one of the biggest questions about ECMO is how long your child might need ECMO. The honest answer is it varies a lot, there's no fixed timeline that fits every child. ECMO is always temporary (a "bridge" to help recovery), not permanent, and the length depends on your child's specific condition, age, how quickly their heart and/or lungs start to improve, and other factors like overall health. Our team checks progress constantly and plans to come off ECMO as soon as it's safe.

Here's a realistic sense of what families often see in children's hospitals:

How Long It Usually Lasts

• For many kids, ECMO support lasts from a few days up to a couple of weeks.
• Shorter times (just several days) can happen when the lungs or heart recover more quickly with the help of the machine, medications, and gentle breathing support.
• Longer times (several weeks) are more common in tougher cases, like when the lungs are very underdeveloped (such as in congenital diaphragmatic hernia) or when there are multiple issues to work through.
• In some situations, support goes even longer, but the team weighs the benefits carefully every day, and prolonged runs can come with added challenges.

The "Weaning" Process

• ECMO isn't turned off suddenly. The team slowly reduces the machine's support little by little—lowering flows, turning up the ventilator more, and testing if the heart and lungs can handle more work on their own.
• Once off ECMO, your child usually stays on breathing support (ventilator) for additional days to weeks while they build strength.
• Full recovery—breathing without machines, gaining weight, going home—often takes weeks to months after coming off ECMO, with lots of care, therapy, and follow-up.

At Driscoll Children's Hospital in Corpus Christi, the ECMO team (neonatologists, surgeons, perfusionists, nurses, and respiratory therapists) monitors your child around the clock. They track things like oxygen levels, heart function, lung improvement, and overall stability, and they adjust the plan daily. They'll keep you updated honestly about what they're seeing and what the next steps might look like for your little one.

It's completely normal to feel worried about the uncertainty, every child's path is unique, and many families see amazing progress even after longer periods on ECMO.

It is not possible to specifically state the chances of survival. The survival chances must be individualized with careful consideration of the cause of the lung and/or heart disease, the hospital course before ECMO support and the course while on ECMO. Remember that ECMO is only offered to children who have a potential for healthy survival.

ECMO is a lifesaving tool when a child's heart or lungs are failing badly, but it comes with risks, and the long-term outlook varies depending on why ECMO was needed, how long it was used, any complications like brain injury during the process, and the child's underlying condition.

Many children who survive to leave the hospital do go on to have good quality of life and reach important milestones. They attend regular school (sometimes with extra support like tutoring or an individualized education plan), participate in activities, make friends, and grow into independent adults who work, drive, and build their own lives.

With early and consistent therapy—physical, occupational, speech, or developmental support starting in the hospital and continuing after discharge—many of these children make excellent progress. Regular follow-up with specialists (like pediatric neurologists or developmental pediatricians) helps catch things early and adjust support as needed.

At Driscoll Children's Hospital, we emphasize structured follow-up after ECMO. This includes regular developmental assessments, neurologic checks, and therapies to maximize every child's potential. We'll track your child's progress closely, celebrate the improvements, and adjust plans as they grow.

Yes, your child will need follow-up care after ECMO, and it's an important part of helping them recover fully and reach their best potential. Children who have been on ECMO are at higher risk for certain long-term effects because of the severity of the illness that required ECMO, as well as potential complications during treatment (such as effects on the brain, lungs, heart, or growth).

What Follow-Up Typically Includes

Before leaving the hospital (predischarge):

• Thorough medical and neurologic evaluations (including head imaging if needed, hearing screens, and basic developmental checks).
• Education for you and your family about what to watch for, signs of potential issues, and how to coordinate ongoing care.
• Planning for therapies or specialists as soon as your child is stable.

After discharge (ongoing):

• Regular visits with your child's primary pediatrician for general health, growth, and vaccinations.
• Disease-specific care for the original condition (e.g., pulmonologist for lung issues, cardiologist if heart-related).
• Structured neurodevelopmental follow-up: This often involves developmental pediatricians and neurologists. They assess things like motor skills, learning, behavior, speech, and school performance at key ages (e.g., 6–12 months, preschool, school entry, and later grades).
• Therapies as needed: Physical, occupational, speech, or feeding therapy; vision/hearing support; or behavioral/psychological help.
• Monitoring for any new issues that can appear over time, such as subtle learning challenges, coordination difficulties, or growth concerns.

The frequency and exact components depend on your child's age, the reason for ECMO, any complications during ECMO (like neurologic events), and how they're progressing. Some children need only routine checks with occasional specialist input, while others benefit from more frequent evaluations.