Interned by covid, Paulo Gustavo initiates therapy for ECMO; technical understanding – 03/04/2021

Interned by covid, Paulo Gustavo initiates therapy for ECMO; technical understanding – 03/04/2021
Interned by covid, Paulo Gustavo initiates therapy for ECMO; technical understanding – 03/04/2021
Paulo Gustavo, hospitalized with covid-19, presented worsening of lung function on Friday (2). The staff explained that, for “therapeutic readjustments”, the artist evolved to therapy by ECMO (Extracorporeal Membrane Oxygenation) in the ICU.

The technique works by means of a machine, capable of acting as an artificial lung and heart for patients with compromised organs. Highly complex, ECMO can be used on people of all ages, from newborns to the elderly. Because of the serious respiratory problems that covid-19 brings, it has been widely used in hospitals.

ECMO has a more complex action in relation to the mechanical ventilator, which does not replace the function of the lung, but only provides an air flow into them. On the other hand, the technique used in Paulo Gustavo works as an additional lung and allows the patient to have time and clinical condition to recover.

How ECMO works

The technique performs artificial blood circulation and oxygenation using a machine connected to the patient through catheters.

The highly complex procedure is performed in severe cases in which the patient suffers severe pulmonary or circulatory impairment, which could lead to death, increasing the chances of survival.

What are the main benefits that ECMO offers?

  • Balance circulation quickly and effectively;
  • Allow time for the lung or heart to recover;
  • Keep the heart and / or lung functioning while the patient treats the cause that led to the use of ECMO;
  • Possibility of receiving hemodialysis or performing surgical procedures in parallel with the use of the machine.

Risks of using ECMO

Hemorrhage
This may be because the blood must be kept anticoagulated to prevent it from clotting in the tubing. Knowing the risk, the trained team follows the patient closely. If bleeding increases, ECMO may need to be stopped.

Infection
The risk is common for all procedures that require tubes in the body, especially within a blood vessel.

Embolism
Small clots or air bubbles can get into the blood in the tubes. Sometimes they can cause injury to other parts of the body and even be fatal.

Stroke
The carotid artery is used in ECMO using the veno-arterial blood vessel. This artery is one of the vessels that carry blood to the brain. During or after ECMO, there is a possibility of obstruction.

The long-term risks are not known and an increased chance of stroke can occur as a person ages. In addition, both the bleeding and the embolisms described above can cause stroke.

For which cases is the equipment recommended or contraindicated?

For the patient to receive ECMO indication, it is necessary that his condition is reversible, since it is not possible to leave him in the machine forever. The indications are diverse and must be well evaluated by a team with specialized training to use the technology. Among the most common are:

  • Acute respiratory failure (due to the inability of oxygenation of the blood or lung to eliminate carbon dioxide).
  • Newborns who have heart or lung problems, such as meconium aspiration syndrome, characterized by the difficulty in breathing in the baby who aspirated sterile fecal matter called meconium into the lungs before or close to the time of delivery.
  • Severe pneumonia or bronchiolitis.
  • Postoperative surgeries when the organ has not yet returned to normal operation.
  • Inflammation or heart failure (myocarditis).

Among the contraindications, doctors point out:

  • Children with gestational age less than 34 weeks and birth weight less than 200 grams, since the equipment is too big for them.
  • Patients who have spent a long time on ventilation and already have lung damage.
  • Severe coagulopathy and / or hemorrhage.
  • Other congenital anomalies.
  • Multiple organ failure.
  • Irreversible lung or cardiovascular diseases.

* With information from a report published on 06/17/2020.

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