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Pediatric Extracorporeal Membrane Oxygenation (ECMO) treatment is a life support procedure that is used for children with fatal lung or heart problems. It offers long-term heart and breathing support. It is a highly-specialized treatment that is only used when all other standard treatments have failed. Through ECMO treatment, a child can be supported for several days or weeks while the doctor tries to treat the underlying illness. How does it work? A heart-lung bypass machine is used to perform pediatric ECMO treatment that is similar to the machine used in open-heart surgical procedures. Also known as ‘circuit’, the ECMO machine is large and has a sterilized plastic tubing for moving blood between your child and the ‘ECMO lung’. The ECMO machine will be adding oxygen to your child’s blood and removing carbon dioxide, just like your healthy lung. ECMO machine is of two types: Venovenous (V-V) ECMO - The doctor will use this machine if your child’s heart functions properly and only the lungs must be rested and healed. Venoarterial (V-A) ECMO - The doctor will use this machine if neither the heart nor the lungs are functioning properly and must be rested and healed. When does your child need the ECMO machine? Through ECMO, your child can get help with a wide range of medical conditions, including the following: Meconium Aspiration Syndrome (MAS) - This condition occurs when the newborn’s first stool, known as meconium, is inhaled by them before delivery. This
can result in severe lung problems. Respiratory Distress Syndrome (RDS) - This is a lung condition that mostly affects babies by making it difficult for them to breathe. Congenital Diaphragmatic Hernia (CDH) - This condition results in the intestines or the stomach protruding through the diaphragm inside the chest cavity. Persistent Pulmonary Hypertension of a newborn (PPHN) - This disorder is characterized by unusually high blood pressure in the arteries supplying blood to
the lungs. Congenital heart conditions Respiratory failure or end-stage cardiac failure Pneumonia Sepsis What to expect during the Pediatric ECMO treatment? It is important that you find the best pediatrician near you to get a consultation regarding the ECMO treatment since this is a complicated treatment. During the ECMO treatment, your child will have cannulas attached to them. Cannulas are large tubes made of plastic inserted into the child’s blood vessels. A doctor will place the tube after administering anesthesia on your child. Through these cannulas, the doctor will have direct access to the heart. The blue tube will take deoxygenated blood from the heart, from the body, and inside the ECMO machine where oxygen is added to it. The red tube will take the oxygenated blood from the ECMO machine and pump it into the aorta. Even though the ECMO machine will be doing all the lung’s work for your child, they will be attached to a breathing machine so that a controlled amount of oxygen and pressure is delivered to their lungs. Also, through the machine, your child’s body will be able to remove carbon dioxide, when it is expelled during exhalation. A breathing tube called an Endotracheal tube (ET tube) will be inserted inside the mouth or nose connecting the breathing machine to the lungs. After the ECMO treatment, lines and tubes will remain attached to your child, as they did before the treatment. This includes the nasogastric tube, placed inside the nose to reach the stomach for decompressing and emptying the acid from the stomach, intravenous lines, for providing medications and fluids, and another tube into the bladder for draining urine. In some cases, a tube will be placed into your child’s chest for draining fluid or air present outside the lungs. What can you do as a parent? When your child is on the ECMO treatment, it can be an emotional and traumatic experience for you and your family. The whole experience is full of ups and downs. Here are a few tips that can help you go through this: 1. Apart from taking care of your child, you need to take care of yourself as well. Don’t be sitting next to your child’s bed at all times. Sleep, eat and go
outside every day. You must be alert and rested so that you can make better decisions about the medical care of your child.
2. Try to be more involved and active in your child’s care. You won’t have any medical training and understanding the medical information and terminology
will be difficult. What you can do is ask questions about what is happening so that you can make informed decisions. The hospital staff at the Rainbow
Children’s Hospital will ensure that all your questions are answered. You can also talk to them about the issues that are concerning you.
If you have any concerns regarding your child’s ECMO treatment, you can contact the best pediatrician in Delhi available at the Rainbow Children’s Hospital.
Consultant Pediatric Pulmonologist
Rainbow Children's Hospital, Banjara Hills