If you’re reading this from an ICU waiting room, you’re doing something hard. You showed up. You stayed. That matters.

Today might not look like Christmas. The day can feel slow, loud, confusing, and unfair. Machines beep. Plans change. Updates come in pieces. You may feel calm one minute and wrecked the next. That’s normal.

Here’s what I hope you remember today:

1. Your presence helps, even when you don’t know what to say.

2. It’s okay to take breaks. Eating, sleeping, and stepping outside are part of staying strong.

3. You don’t need to understand every number on the screen to be a good advocate.

If you want something practical to do today, try this:
Ask the bedside nurse or provider these three questions:

1. What are the main goals for the next 24 hours?

2. What would make today a “good day” medically?

3. What signs would mean we’re moving in the right direction?

Then write the answers down. It helps when you’re tired. It also helps when different family members rotate in.

If your loved one is awake, even a little, simple is best:
“I’m here. You’re safe. We’re taking it one step at a time.”

If your loved one is sedated, talk anyway. Familiar voices can still matter:
“It’s Christmas. I love you. I’m staying close.”

And if you’re carrying guilt, fear, or anger today, you don’t need to fix it in one sitting. Just get through the next hour. Then the next.

Merry Christ mas. You’re not failing because this is hard. This is hard because it matters.

Key Points:

• ECMO stands for extracorporeal membrane oxygenation.

• It’s a temporary life support system used when the heart or lungs are failing.

• ECMO gives time for the body to rest and recover or for other treatments to take effect.

• It requires a highly skilled medical team and is used in critical care units.

What Is ECMO?

ECMO is a life-saving machine that takes over the work of the heart and/or lungs when they can't do their job correctly. It removes blood, adds oxygen, removes carbon dioxide, and sends the blood back into the body. This process gives doctors time to treat the underlying condition without the body shutting down due to lack of oxygen.

Think of your heart and lungs as a power plant. If they stop working due to injury or illness, ECMO acts as a temporary backup system to keep the body running.

When Is ECMO Used?

ECMO is typically used in very sick patients when other treatments haven’t worked. Here are some examples showing the kinds of serious conditions where ECMO might help:

• Severe pneumonia or lung injury where a ventilator isn’t enough.

• Heart failure due to heart attack or surgery.

• Cardiac arrest when CPR isn’t working.

• Patients waiting for a heart or lung transplant.

• After significant heart or lung surgery to help with recovery.

Doctors use ECMO only when there’s a reasonable chance that the patient’s condition could improve with time and support.

Does ECMO Cure the Problem?

No, ECMO doesn’t fix the root problem. It keeps the body functioning while doctors work on the actual issue—whether that means fighting infection, repairing damage, or preparing for a transplant. It’s like putting a car in neutral while the engine gets repaired.

How Does It Work?

To connect a patient to ECMO, doctors insert large tubes (called cannulas) into major veins or arteries, usually in the neck or groin. Blood is taken out, pumped through an oxygenator—an artificial lung that works like your real one by adding oxygen and removing carbon dioxide—and returned to the body.

There are two main types:

• Veno-venous (VV) ECMO: Supports the lungs.

• Veno-arterial (VA) ECMO: Supports both the heart and lungs.

The type used depends on the patient’s condition. The setup can be tailored to their size, age, and medical needs.

What Are the Risks?

ECMO is complex and can lead to serious complications:

• Bleeding: Blood thinners are used to prevent clots, increasing bleeding risk.

• Infection: Inserting tubes increases the risk of infection.

• Clots: Clots can still form despite precautions.

• Organ issues: Including problems with blood flow to limbs or kidneys.

Doctors monitor patients very closely. The ICU team checks every detail—blood pressure, oxygen levels, and signs of complications—and constantly adjusts treatment to reduce risks and improve outcomes.

Who Decides to Use ECMO?

A team of doctors—including specialists in heart care, lung care, and intensive care—evaluates the situation. If they believe ECMO could help, they speak with the patient (if possible) or the family to explain the risks, benefits, and goals. Informed consent is part of this process.

What Should Families Expect?

If your loved one is on ECMO, here’s what you might see:

• The patient is in the ICU and may be unconscious or sedated.

• The ECMO machine is large and connected by thick tubes.

• Treatment may last a few days to several weeks.

• Progress may be slow, and outcomes can be uncertain.

The care team will provide regular updates and explain each step. You can support your loved one by staying involved, asking questions, and looking after your own well-being. Many hospitals have chaplains, social workers, and support services to help families through this experience.

Final Thought

ECMO is one of the most advanced forms of life support available today. While it’s not a guarantee of recovery, it can offer a fighting chance. If your loved one is on ECMO, it means the medical team is doing everything possible to support them through a very serious illness. Stay involved, ask questions, and don’t hesitate to reach out for both emotional and informational support—the team is there for you, too.

Key Points:

• David Richards was a healthy 48-year-old when swine flu triggered a cascade of critical illness.

• Within days, he developed severe ARDS and was placed on ECMO at Glenfield Hospital in the UK.

• Complications, including bleeding and pneumothorax, nearly ended his life.

• His recovery included weeks of coma, vivid hallucinations, and grueling physical rehab.

• More than a decade later, David still lives with the long-term effects—but also with deep gratitude.

In late 2009, David Richards caught what seemed like a typical seasonal flu. He called in sick to work on Friday, November 27, thinking he’d be back by Monday.

He never returned.

Over the next two weeks, his symptoms worsened. He called his GP three times, describing crushing fatigue and breathlessness. Each time, he was told to drink fluids, take paracetamol, and rest. But his condition spiraled. A friend who was with him remembers hearing him say on the phone, “Please help me—I feel like I’m dying.”

He wasn’t exaggerating.

A Sudden Collapse

When David stopped answering calls, his parents, 150 miles away, drove to check on him. They found him incoherent, barely breathing. Paramedics rushed him to Gloucestershire Royal Hospital, where he was placed in a medically induced coma and ventilated. He had developed ARDS (Acute Respiratory Distress Syndrome), a life-threatening condition where fluid fills the lungs, blocking oxygen from entering the blood.

Despite prone positioning and maximum ventilator settings, David’s oxygen levels continued to drop. His local ICU team had exhausted all options.

The Call to Glenfield

Glenfield Hospital in Leicester—then the UK’s only adult respiratory ECMO center—was contacted. With only five ECMO beds, placement was rare. But David was accepted. A mobile retrieval team arrived with ECMO equipment, placed him on the circuit bedside, and transported him under police escort.

“He had three hurdles,” the consultant told David’s family. “Survive the transfer. Survive cannulation. And survive the complications of ECMO itself.”

The Fight for Survival

Connected to ECMO, David’s blood was now oxygenated outside his body. His lungs could rest.

But survival wasn’t guaranteed.

He developed a double pneumothorax. A tracheostomy was performed. And then came the bleeding—persistent hemorrhaging from his neck and chest tubes. At one point, he was losing 300ml of blood every 90 minutes, despite multiple transfusions.

Eventually, ECMO had to be discontinued. Miraculously, his lungs had recovered enough to function with ventilator support alone. He was transferred back to Gloucestershire Royal ICU—still unconscious, unaware of how close he had come to death.

Waking Up in a Different World

When David began to regain consciousness, nothing made sense.

In his mind, he’d been living in a dream—except it wasn’t peaceful. It was terrifying. He believed he’d been shot. That his daughters were kidnapped. That he was dying all over again.

These were ICU hallucinations, a form of ICU delirium common in long-term sedation. But they felt real.

What helped anchor him was an ICU diary kept by the mother of his baby son and his parents. It chronicled phone calls, procedures, daily updates, and simple words of love. That diary became his map back to reality.

“It helped me filter out the false memories and piece together what actually happened,” he wrote.

Communication and Rehab: Starting from Zero

Physically, David was starting from scratch. He couldn’t speak due to his trach. Early attempts to write or use an alphabet board were frustrating and exhausting. Even holding a phone was impossible.

Eventually, a Passy-Muir valve allowed him to speak—weakly and only for a few minutes at a time. But it was a start.

Rehab began with simple movements: lifting his foot, and rotating his ankle. A former athlete, David had pushed through pain before—but nothing like this.

“I’ve sprinted until I threw up. But trying to sit up in bed was another level.”

Discharge: But Not the End

Two weeks after returning from Glenfield, David was weaned off the ventilator. His trach and feeding tube were removed. He transitioned to the respiratory ward, still in a wheelchair.

His first real meal in nearly two months—sausage, beans, and chips—was photographed to mark the occasion.

Eventually, he stood. Then shuffled with a walker. His daughters pushed him to the shop in a wheelchair. It took eight months before he could set the wheelchair aside for good.

Life After ICU

Going home was not a victory lap. It was the beginning of a new struggle.

David joined outpatient rehab, eventually spending over 2.5 years in various programs. He battled fatigue, joint pain, short-term memory loss, and crushing disappointment. His career in defense and intelligence—nearly 30 years—ended in medical retirement at age 49.

He was also diagnosed with PTSD. The nightmares persisted. He underwent CBT and then EMDR therapy, which finally helped him cope.

The Long View

Years later, David returned to Glenfield to thank the team that saved him. He stood in front of the ECMO machine, which gave him time to heal.

“My son was four months old when I got sick. He’s now twelve. And he has a father in his life because of ECMO. That’s the bottom line.”

Takeaway

ECMO doesn’t just save lives—it gives people the chance to live again. But survival is only part of the story. The emotional, physical, and financial toll of recovery is real, long-lasting, and often invisible.

David’s journey reminds us that every ECMO survivor walks a road few can understand—but one worth walking.

Postscript (From David Richards):

After reading this article, David shared that Glenfield Hospital had a reciprocal arrangement with Karolinska University Hospital in Sweden prior to 2009, allowing patients to be flown between the two when ECMO beds were full. He considers himself incredibly fortunate to have received a bed in time. His survival—along with others during the 2009 and 2010 swine flu waves—helped influence the creation of a centrally funded regional network of adult respiratory ECMO centers in England.

Thanks for reading ECMO 143: A Patient & Family Guide! Subscribe for free to receive new posts and support my work.

Navigating the ICU and ECMO can feel overwhelming, especially with so many unfamiliar terms. This glossary is designed to empower you with clear, simple explanations of the medical language you might encounter. Whether you're a patient, family member, or caregiver, we hope this guide brings clarity and comfort during a challenging time. Each term is explained in plain English, with pronunciation help and emoji icons to make learning easier. This is your companion as you walk through one of life’s most critical moments — we’re here to help you feel informed, confident, and supported.

Thanks for reading ECMO 143: A Patient & Family Guide! You can subscribe for free to receive new posts and a free ECMO & ICU Glossary PDF.

A

ACT (Activated Clotting Time)
🧪 ay-see-tee
A bedside test that checks how long it takes for blood to clot. Used to monitor blood thinners and avoid clots in the ECMO circuit.

ARDS (Acute Respiratory Distress Syndrome)
🫁 ar-dz
A serious lung condition where fluid fills the lungs, making breathing hard. Often a reason someone may need ECMO.

A-line (Arterial Line)
💉 ay-line
A small tube placed in an artery, usually in the wrist. Used to check blood pressure and draw blood easily.

ABG (Arterial Blood Gas)
🧪 ay-bee-jee
A test that measures oxygen, carbon dioxide, and pH levels in the blood. Helps guide ECMO and ventilator settings.

Anticoagulant
💊 an-tee-co-AG-you-lant
A medication that prevents blood clots. Examples include heparin and bivalirudin.

Anoxic Brain Injury
🧠 uh-NOX-ick
Brain injury caused by a lack of oxygen. May happen after cardiac arrest or severe respiratory failure.

Afterdrop
❄️ af-ter-drop
A further drop in body temperature after rewarming. Watched closely after hypothermia treatment.

Air Embolism
🫧 air EM-boh-lizm
A dangerous condition where air enters the bloodstream. Can block blood flow and cause serious complications.

B

Bicarb (Bicarbonate)
🧪 BYE-karb
A substance that helps correct acid in the blood. Sometimes given during ECMO when the body becomes too acidic.

Bleeding
🩸 BLEE-ding
A common ECMO complication due to blood thinners. Watched closely, especially around cannula sites.

Blood Culture
🧪 bluhd KUL-chur
A test to check for infections in the blood. Important if a patient has a fever or signs of sepsis.

Blood Flow (ECMO Flow)
💓 bluhd floh
The amount of blood moving through the ECMO circuit each minute. Higher flow = more support.

Bivalirudin
💊 bye-VAL-uh-roo-din
A blood thinner used in some ECMO patients instead of heparin. It may reduce the risk of clots or bleeding.

Bridge to Transplant
🏥 brij too TRANS-plant
Using ECMO to keep a patient alive while waiting for a heart or lung transplant.

Barotrauma
💥 BAIR-oh-traw-muh
Lung injury caused by high pressure from a ventilator. Can lead to collapsed lungs or other complications.

C

Cannula
🧯 CAN-you-lah
A large tube placed in blood vessels to connect to ECMO. One takes blood out, the other puts it back in.

Circuit
🔁 SIR-kit
The tubing, pump, and oxygenator system of ECMO. Blood flows through this “external lung.”

Clot
🩸 klot
A clump of thickened blood. Can block ECMO flow or cause serious complications.

CO₂ (Carbon Dioxide)
🌫️ see-oh-too
A waste gas the body needs to get rid of. ECMO can help remove it when lungs can't.

CRRT (Continuous Renal Replacement Therapy)
💧 see-ar-ar-tee
A gentle form of dialysis used in ICU patients. Often needed when kidneys stop working.

Central Line
💉 SEN-tral line
A long IV tube in a big vein. Used to give medications and draw blood in the ICU.

Chest Tube
🧽 chest toob
A tube placed in the chest to remove air, blood, or fluid from around the lungs. Helps the lungs expand properly.

D

D-dimer
🧪 dee-DYE-mer
A lab test that checks for clot formation or breakdown. Often elevated in patients on ECMO.

Decannulation
🗓️ dee-CAN-you-lay-shun
Removing the ECMO cannulas. Means the patient no longer needs ECMO support.

Delirium
🧠 duh-LEER-ee-um
Temporary confusion or disorientation. Common in the ICU and often reversible.

Dobutamine
💊 doe-BYOO-tuh-meen
A medicine that helps the heart pump stronger. Used for low blood pressure or weak heart function.

Drips (IV Drips)
💉 drips
Constant IV medicines given by a pump. Can include sedatives, blood pressure meds, or blood thinners.

Differential Hypoxia
🫀 DIFF-er-EN-shul hy-POX-ee-uh
A situation during VA ECMO where different body parts get different oxygen levels. Can lead to low brain oxygen if not corrected.

E

ECMO (Extracorporeal Membrane Oxygenation)
🫁 ek-moh
A machine that helps the heart and/or lungs by taking over their function. It adds oxygen to blood and removes carbon dioxide outside the body.

ECPR (Extracorporeal Cardiopulmonary Resuscitation)
❤️ ee-see-pee-ar
Emergency ECMO started during CPR if the heart stops. Gives time to treat the cause while supporting the body.

Echocardiogram (Echo)
🩺 eh-ko-CAR-dee-oh-gram
An ultrasound of the heart. Shows how well the heart is pumping and if ECMO is needed.

EEG (Electroencephalogram)
🧠 ee-ee-jee
A test that checks brain activity using small sensors on the head. Used to detect seizures or brain function in sedated patients.

Electrolytes
🧂 ee-LEK-tro-lites
Minerals like sodium, potassium, and calcium. Needed for heart rhythm, nerves, and fluid balance.

Extubation
🫁 eks-too-BAY-shun
Removing the breathing tube when someone can breathe on their own again. A major milestone in ICU recovery.

F

FiO₂ (Fraction of Inspired Oxygen)
🌬️ eff-eye-oh-too
The percent of oxygen a person receives through a ventilator or ECMO. 100% is pure oxygen; room air is 21%.

Flow (ECMO Flow)
💓 floh
How much blood the ECMO circuit is pumping per minute. Measured in liters per minute to guide support levels.

Fluid Overload
🫗 floo-id OH-ver-lohd
When the body holds too much fluid, causing swelling or lung issues. Treated with diuretics or dialysis.

Foley Catheter
🛁 foh-lee KATH-uh-ter
A tube in the bladder that drains urine. Helps monitor kidney function and fluid levels.

Functional Status
🧍 FUNK-shun-al STAY-tus
How well someone can move, think, and care for themselves. Tracked before and after ECMO to guide rehab.

G

GCS (Glasgow Coma Scale)
🧠 gee-see-ess
A score that measures how alert someone is. Ranges from 3 (deep coma) to 15 (fully awake).

G-tube (Gastrostomy Tube)
🍽️ gee-toob
A feeding tube placed directly into the stomach. Used when someone can’t eat by mouth.

Glucose
🍬 gloo-kose
Blood sugar that gives the body energy. Kept in a safe range to support healing.

Genetic Condition
🧬 jeh-NET-ick con-DISH-un
A health issue someone is born with. May affect how they respond to illness or ECMO.

H

Heparin
💉 HEP-er-in
A blood thinner used to prevent clots during ECMO. Dosed carefully and monitored with blood tests.

Hypoxia
🫁 hy-POX-ee-uh
Low oxygen in the body or brain. A key reason someone may need ECMO.

Hypothermia (Therapeutic)
❄️ hy-po-THER-mee-uh
Cooling the body to protect the brain. Used after cardiac arrest, sometimes with ECMO.

Hypercapnia
🌫️ hy-per-CAP-nee-uh
Too much carbon dioxide in the blood. Can cause sleepiness or confusion if untreated.

Heart Failure
❤️ hart FAYL-yer
When the heart can’t pump enough blood. VA ECMO may be needed for support.

Hematocrit
🧪 hee-MAT-oh-krit
The percent of blood made up of red blood cells. Helps track anemia or blood loss.

Hallucination
🌀 ha-loo-sin-AY-shun
Seeing or hearing things that aren’t there. Common in ICU patients with delirium.

Hand Hygiene
🧼 hand HYE-jeen
Washing hands to prevent infection. One of the most important ways to protect ICU patients.

Healthcare Team

Perfusionist
👨‍🔬 per-FYOO-zhun-ist
A specialist who runs the ECMO machine. They monitor flow, pressures, and the oxygenator 24/7.

Intensivist
🩺 in-TEN-sih-vist
A doctor who specializes in critical care medicine. They oversee the patient’s overall care in the ICU.

ECMO Specialist
🫁 ek-moh SPESH-uh-list
A nurse or perfusionist with advanced training in ECMO management. They troubleshoot the circuit and ensure it’s working properly.

Respiratory Therapist (RT)
🌬️ res-pih-RAH-tor-ee ther-uh-pist
A healthcare professional who manages the ventilator and helps with breathing treatments.

Nephrologist
💧 neh-FRAHL-oh-jist
A doctor who specializes in kidney care. They manage dialysis and kidney-related issues.

Palliative Care Team
🌿 PAL-ee-uh-tiv kair team
A team that focuses on comfort, goals of care, and family support. They help with decision-making in complex ECMO cases.

Physical Therapist (PT)
🏋️ FIZ-ih-kul ther-uh-pist
A specialist who helps patients regain strength and mobility, even while on ECMO.

Social Worker
🤝 SOH-shul WUR-ker
A professional who provides emotional support, helps with resources, and assists with discharge planning.

I

ICU (Intensive Care Unit)
🏥 eye-see-you
A hospital unit for the sickest patients. ECMO patients are always cared for in the ICU.

Intubation
🫁 in-too-BAY-shun
Putting a tube into the windpipe to help someone breathe. Most ECMO patients are intubated.

INR (International Normalized Ratio)
🧪 eye-en-are
A blood test that checks clotting time. Used with blood thinners like warfarin or heparin.

Infusion Pump
🖥️ in-FYOO-zhun pump
A machine that gives medicine through an IV. Used to control drips like sedation and blood pressure meds.

IV (Intravenous Line)
💧 eye-vee
A tube placed into a vein to give fluids or medicine. ICU patients often have several IVs.

Ischemia
🧊 iss-KEE-mee-uh
When blood flow to part of the body is too low. Can cause serious damage if not fixed.

J

Junctional Rhythm
🫀 JUNK-shun-uhl RITH-um
A heart rhythm starting near the AV node. May happen after surgery or in critically ill patients.

Jugular Vein
🧍 JUG-yoo-lar vane
A large neck vein used for ECMO cannulas or central lines.

K

Ketamine
💊 KEH-tuh-meen
A sedative used in the ICU. Can help keep blood pressure stable.

Kidney Function
💧 KID-nee FUNK-shun
How well the kidneys clean blood and balance fluids. Dialysis may be used if kidneys fail.

Kangaroo Care
🦘 KANG-uh-roo kair
Skin-to-skin contact between baby and parent. Sometimes possible even during ECMO with help.

L

Lactate
🧃 LAK-tate
A chemical that rises when the body lacks oxygen. Tracked to see if ECMO is helping.

Left Heart Decompression
🧯 left hart dee-com-PRESH-un
Relieves pressure in the heart during VA ECMO. Protects the lungs and heart from damage.

LVAD (Left Ventricular Assist Device)
⚙️ el-vad
A mechanical pump that helps a weak heart. Sometimes used instead of ECMO or after it.

Liver Enzymes
🧫 LIV-er EN-zimes
Blood tests that show liver health. Checked often in ICU and ECMO patients.

Line Infection
🦠 line in-FEK-shun
An infection where a central line enters the body. Prevented with careful cleaning and monitoring.

Level of Consciousness
🧠 LEV-uhl of CON-shuss-ness
How awake and aware someone is. Assessed often in ICU care.

M

MAP (Mean Arterial Pressure)
🩺 em-ay-pee
The average pressure in the arteries during one heartbeat. Used to check if blood is reaching the brain and organs.

Mechanical Ventilation
🫁 meh-KAN-ih-kul ven-till-AY-shun
A machine (ventilator) helps a person breathe. Often used before or during ECMO.

Metabolic Acidosis
🧪 meh-tuh-BAH-lik ass-id-OH-sis
When the body is too acidic due to poor oxygen or kidney failure. Can be treated with bicarbonate and ECMO.

Milrinone
💊 MIL-rih-known
A medication that helps the heart pump more effectively. Used in heart failure or shock.

Mobilization
🧍 mo-bill-eye-ZAY-shun
Helping patients move while still in the ICU. Improves strength, recovery, and outcomes — even on ECMO.

N

Neuromuscular Blockade
🛌 nur-oh-MUSS-kyoo-lar BLAH-kade
A medication that causes temporary paralysis. Used with sedation to allow healing or prevent movement during ECMO.

Nitric Oxide (iNO)
🌬️ NIGH-trick OX-side
A gas that opens blood vessels in the lungs. Improves oxygen levels during severe lung failure.

Nutrition (Enteral or Parenteral)
🥣 new-TRISH-un
Food given through a tube (enteral) or IV (parenteral). Supports healing when a patient can't eat normally.

Nephrology
💧 neh-FRAHL-oh-jee
The branch of medicine focused on the kidneys. Nephrologists help manage dialysis in ECMO patients.

O

Oxygenator
🫁 ox-ih-JEN-ay-tor
The “artificial lung” in the ECMO circuit. Adds oxygen and removes carbon dioxide from the blood.

Oxyhemoglobin
💉 ox-ee-HEE-moh-gloh-bin
Hemoglobin in red blood cells that is carrying oxygen. Tells us how well oxygen is being delivered.

Oxygen Index (OI)
📊 OX-ih-jen IN-dex
A number used to show how bad someone’s lung failure is. Helps decide if ECMO might be needed.

Organ Perfusion
💓 OR-gun per-FYOO-zhun
How well blood is reaching organs like the brain and kidneys. A key goal of ECMO is to improve perfusion.

P

Palliative Care
🌿 PAL-ee-uh-tiv kair
A team that focuses on comfort, goals of care, and family support. They can help with decision-making in complex ECMO cases.

PEEP (Positive End-Expiratory Pressure)
🌬️ peep
A ventilator setting that keeps lungs open between breaths. Important in ARDS and ECMO management.

Percutaneous Cannulation
🧷 per-kyoo-TAY-nee-us can-you-LAY-shun
Placing ECMO tubes through the skin using a needle and guidewire. Less invasive than open surgery.

Perfusionist
👨‍🔬 per-FYOO-zhun-ist
A specialist who runs the ECMO machine. They monitor flow, pressures, and the oxygenator 24/7.

Platelets
🩸 PLATE-lets
Blood cells that help stop bleeding. Watched closely on ECMO due to clot and bleeding risks.

Q

QT Interval
🫀 cue-tee IN-ter-val
A part of the heart rhythm seen on an EKG. Long QT can lead to dangerous arrhythmias.

Quaternary Care Center
🏥 KWAW-ter-nair-ee kair sen-ter
A hospital with advanced treatments like ECMO and transplants. Patients may be transferred here for specialized care.

R

Recovery
💪 reh-KUV-er-ee
The process of healing after critical illness. May take weeks or months after ECMO.

Renal Failure
💧 REE-nal FAYL-yer
Kidney failure requiring dialysis. Common in ICU patients on ECMO.

Respiratory Failure
🫁 RES-pih-rah-tor-ee FAYL-yer
When the lungs can’t get oxygen or remove CO₂. Often treated with ventilators or ECMO.

RRT (Respiratory or Renal Replacement Therapy)
🔄 ar-ar-tee
Can mean respiratory therapy or continuous dialysis. Both support the body during ECMO.

Rounds (Medical Rounds)
🩺 rowndz
The daily team discussion at the bedside. Families may attend and ask questions.

S

Sedation
😴 seh-DAY-shun
Medicine to keep patients calm or asleep. Carefully adjusted during ECMO.

Sepsis
🦠 SEP-sis
A life-threatening reaction to infection. Can lead to organ failure and need for ECMO.

Shock
⚡ shahk
When the body doesn’t get enough blood flow. Often treated with fluids, meds, or ECMO.

Sweep (Sweep Gas)
🌬️ sweep
The ECMO setting that controls CO₂ removal. Acts like a dial for artificial lungs.

SpO₂ (Oxygen Saturation)
🫁 ess-pee-oh-too
Shows how much oxygen is in the blood. Watched closely on the monitor.

Steroids
💊 STAIR-oydz
Medicines that reduce inflammation. Used in ARDS, shock, or certain illnesses.

Stroke
🧠 strohk
When blood flow to part of the brain is blocked. A rare but serious complication of ECMO.

T

Tracheostomy (Trach)
🫁 tray-kee-OSS-tuh-mee
A breathing tube placed through the neck. Helps long-term breathing support and comfort.

Tachycardia
❤️ tak-ih-KAR-dee-uh
A fast heart rate. May be treated if it causes problems.

Tidal Volume
🌬️ TYE-dul VOL-yoom
The amount of air moved in and out of the lungs with each breath. Set on the ventilator to protect the lungs.

Transfusion
🩸 trans-FYOO-zhun
Giving blood or blood products through an IV. Needed if there is bleeding or anemia.

Trial-off (ECMO Trial-off)
🧪 TRY-uhl off
A test where ECMO is turned off temporarily. Used to check if the patient is ready to come off.

U

Ultrasound
🖥️ ULL-truh-sownd
A test using sound waves to see inside the body. Used to guide cannulas or assess heart and lungs.

Unfractionated Heparin
💉 un-FRACK-shuh-nay-tid HEP-er-in
The standard form of heparin given by IV. Requires regular blood monitoring.

Urinometer
💧 yur-IN-oh-mee-ter
A device that measures urine output. Used to monitor kidney function.

V

VA ECMO (Venoarterial ECMO)
❤️ vee-ay ek-moh
Supports the heart and lungs. Returns blood into an artery to help circulation.

VV ECMO (Venovenous ECMO)
🫁 vee-vee ek-moh
Supports only the lungs. Blood is returned to a vein.

Ventilator
🫁 VEN-till-ay-tor
A machine that helps someone breathe. Often used before and during ECMO.

Vasopressors
💉 VAY-so-press-ers
Medicines that raise blood pressure. Used in shock or low-perfusion states.

VAP (Ventilator-Associated Pneumonia)
🦠 vap
A lung infection that develops while on a ventilator. Prevented with special care techniques.

W

Wake-up Trial
🛏️ WAYK-up try-uhl
Stopping sedation briefly to assess brain function. Carefully done to check alertness.

Weaning
🌀 WEE-ning
Slowly lowering machine support as the patient improves. Happens with ECMO, ventilation, and drips.

Whiteout (Chest X-ray)
🩻 WHITE-out
When both lungs look completely cloudy on an X-ray. Seen in severe ARDS or fluid-filled lungs.

X

X-ray
🩻 eks-ray
An imaging test to look at bones and organs. Used daily to check lungs and cannula placement.

Y

Young Adult ECMO
👶 yuhng uh-DULT ek-moh
Refers to ECMO care for teens and people in their 20s. Often has different goals or risks than pediatric or adult care.

Y-site (IV Line Y-Connector)
🔀 why-site
A Y-shaped connector on an IV line. Lets multiple meds be given through one line.

Z

Zeroing (Transducer Zeroing)
🎯 ZEER-oh-ing
Calibrating ICU monitors to get accurate readings. Done on devices like A-lines and central lines.

Zinc
🧂 zingk
A mineral that helps the body heal. Sometimes included in ICU nutrition plans.

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Key Points:

• Brittnee's post-childbirth flu progressed to severe pneumonia and sepsis, leading to lung collapse.​

• She underwent 70 days of ECMO therapy at UT Medical Center, facing significant challenges.​

• With ECMO support and a dedicated medical team, Brittnee achieved a remarkable recovery.​

Thanks for reading ECMO 143: A Patient & Family Guide. You can subscribe for free to receive new posts and support my work.

Introduction

Extracorporeal Membrane Oxygenation (ECMO) is a life-saving technique used to support patients with severe cardiac and respiratory failure. By temporarily taking over the functions of the heart and lungs, ECMO allows these vital organs time to rest and heal. This advanced therapy has been pivotal in the recovery of many patients, including Brittnee, whose story exemplifies resilience and the critical role of ECMO in modern medicine.​

Brittnee's Health Crisis

In late 2022, shortly after giving birth to her third child, Brayden, Brittnee began experiencing flu-like symptoms. Despite initial assumptions of a mild illness, her condition rapidly deteriorated. The flu progressed into bacterial and viral pneumonia, severely compromising her respiratory system. Within two weeks, Brittnee developed sepsis—a life-threatening response to infection—and suffered lung collapse. Recognizing the severity of her condition, medical professionals airlifted her to the University of Tennessee Medical Center in December 2022. ​

Initiation of ECMO Therapy

Upon arrival, Brittnee's medical team determined that conventional treatments were insufficient. They decided to initiate ECMO therapy, a decision often reserved for patients with severe, reversible cardiac or pulmonary failure unresponsive to standard interventions. ECMO involves circulating blood outside the body through an artificial lung, oxygenating it, and returning it to the patient's bloodstream. This process allows the heart and lungs to rest and recover.

Challenges During Treatment

Brittnee's journey on ECMO was fraught with complications. One of her lungs detached from the chest wall, leading to internal bleeding. She required surgery to address this issue, and her medical team faced the delicate balance of managing bleeding risks while ensuring adequate anticoagulation—a common challenge in ECMO management. Despite these hurdles, the medical team's expertise and Brittnee's resilience played crucial roles in her recovery.

The Road to Recovery

After 70 days on ECMO, Brittnee was gradually weaned off the machine in March 2023. Transitioning from ECMO support was both a physical and psychological challenge. Brittnee expressed anxiety about relying on her lungs again, highlighting the importance of comprehensive rehabilitation that addresses both physical recovery and mental health. Her journey underscores the need for multidisciplinary support systems in critical care settings. ​

The Role of ECMO in Postpartum Complications

Brittnee's case is a testament to the potential of ECMO in treating severe postpartum complications. While ECMO carries risks, including bleeding and infection, its use in life-threatening situations like Brittnee's has shown promising outcomes. Studies have indicated that ECMO can be a feasible salvage therapy for pregnant and postpartum women with reversible cardiac or respiratory failure.

Conclusion

Brittnee's story is about courage, resilience, and the life-saving potential of advanced medical interventions like ECMO. Her experience highlights the importance of recognizing severe postpartum complications early and the need for specialized treatments. It also emphasizes the critical role of a dedicated medical team in navigating the complexities of ECMO therapy. For patients and families facing similar health crises, Brittnee's journey offers hope and underscores the advancements in medical technology that can lead to recovery even in the most dire circumstances.​

For a deeper insight into Brittnee's experience, watch her story shared by UT Medical Center:

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Guest Editor: Dr. David Jergenson, DPT, a physical therapist at Mayo Clinic in Rochester, MN

In ECMO care, we focus heavily on hemodynamics and oxygenation, but recovery extends beyond the circuit. Early mobilization is key in reducing delirium, shortening hospital stays, and restoring independence, yet it comes with unique challenges.

This week’s guest editor, Dr. David Jergenson, DPT, a physical therapist at Mayo Clinic in Rochester, MN, shares his insights on safely mobilizing ECMO patients. He discusses the barriers, strategies, and interdisciplinary collaboration needed to make movement possible.

Let’s explore how mobilization can transform ECMO recovery:

Like so many in the inpatient population, there are countless benefits to patients on ECMO mobilizing. Not only do patients get stronger, but it also helps reduce delirium, decreasing length of stay and undoubtedly provides hope for the critically ill. As a physical therapist, it’s my job to make it happen.

Patient abilities can vary due to their strength, cognition, hemodynamics, or all of the above, and rates of ICU-acquired weakness in ECMO patients are often higher than those of the general ICU population. Some patients are so debilitated that we focus on sitting balance or performing sit-to-stand exercises for several weeks. If the patient cannot take steps, we sometimes use a ceiling lift or Sara Stedy device to transfer a patient to a chair. Others have the strength to ambulate several hundred feet! Each patient's ECMO journey is unique. Some had complicated cardiac surgery. Others are awaiting heart and/or lung transplants. Regardless of their differences in background and complexity, the goals of returning to independence remain the same.

The Power of Movement in ECMO Recovery

Studies have shown that mobilizing patients on ECMO is overall safe. As with all mobility, risks are always involved, but the benefits far outweigh the low chance of harm. At my facility, we frequently mobilize patients with various cannulation strategies and support (VA, VV, VAV, etc.). There used to be a previous thought that patients who were femorally cannulated needed to be on bedrest; we frequently mobilize these patients and have not had any major adverse events. For these patients, flexing the hip to 90 degrees on the cannulated side while supine helps assess whether ECMO flows change in a seated position.

Interdisciplinary communication is vital for success in mobilizing ECMO patients. There is frequent dialogue regarding line management and patient response to activity between the critical care team, PT, OT, nursing, and the ECMO specialist. The ECMO specialist sometimes increases the FiO2 or sweep to improve patient symptoms or hemodynamics. These changes are documented in our therapy notes for reference in future sessions. We also mobilize patients whose sweep gas is clamped on ECMO, as their activity tolerance can help determine decannulation readiness. The journey for these patients can be very challenging, but the mobility team is undoubtedly integral to recovery.

Sources: Abrams, D., Madahar, P., Eckhardt, C. M., Short, B., Yip, N. H., Parekh, M., Serra, A., Dubois, R. L., Saleem, D., Agerstrand, C., Scala, P., Benvenuto, L., Arcasoy, S. M., Sonett, J. R., Takeda, K., Meier, A., Beck, J., Ryan, P., Fan, E., Hodgson, C. L. (2022). Early Mobilization during Extracorporeal Membrane Oxygenation for Cardiopulmonary Failure in Adults: Factors Associated with Intensity of Treatment. Annals of the American Thoracic Society, 19(1), 90–98. https://doi.org/10.1513/AnnalsATS.202102-151OC

Chatziefstratiou, A. A., Fotos, N. V., Giakoumidakis, K., & Brokalaki, H. (2023). The Early Mobilization of Patients on Extracorporeal Membrane Oxygenation: A Systematic Review. Nursing reports (Pavia, Italy), 13(2), 751–764. https://doi.org/10.3390/nursrep13020066

Chen, X., Lei, X., Xu, X., Zhou, Y., & Huang, M. (2022). Intensive Care Unit-Acquired Weakness in Patients With Extracorporeal Membrane Oxygenation Support: Frequency and Clinical Characteristics. Frontiers in medicine, 9, 792201. https://doi.org/10.3389/fmed.2022.792201

Note: This article is intended for educational purposes only. It should not be used as a substitute for professional medical advice or guidance. Always consult with qualified healthcare professionals for clinical decisions and patient care

📝 Read the original article here: The Aftermath of ECMO: Beyond Survival

Please like, subscribe, and comment with your thoughts or experiences. Let’s keep this important conversation going!

As a newer ECMO specialist, I’m constantly learning from the experiences of those who have been through the ECMO journey. Roughly six months ago, I joined several ECMO survivor support groups and was deeply moved by what I discovered. These groups have become a window into the lives of those who have survived ECMO, and their stories have shocked me in ways I did not expect. It’s clear that while ECMO can save lives, the journey for survivors is far from over.

A Personal Insight: Discovering the Reality of ECMO Recovery

I am currently on vacation in Japan and Vietnam, and I found myself reading through the stories shared in these groups in my free time. Despite being on vacation, I couldn’t stop thinking about these survivors’ challenges. The stories ranged from physical complications to severe psychological struggles, including PTSD and anxiety. These narratives made me reflect on how much we, as a healthcare community, truly know about our patients once they leave the units we work in. The healthcare professionals I know are some of the most dedicated and compassionate individuals. While I understand that hospitals have certain protocols for following up with patients, I often wonder how much we know about the lives of patients and their families after they leave the unit. Given the restrictions in the U.S. on direct follow-up, perhaps we should explore other avenues, such as participating in support groups, to continue offering our support.

The Importance of Support: A Personal Reflection

A few years ago, I walked in on my father shortly after he had taken his own life. The trauma of that moment, combined with life’s challenges, was almost too much to bear. I leaned heavily on friends and God, sought out counseling, and joined an established support group for survivors of suicide called SOS to help me process the grief. Those conversations and the support I received were crucial in helping me find a way forward.

While it was a long and challenging journey, I gradually began to rebuild my sense of well-being. I know firsthand how vital these resources can be in recovering from trauma. It’s made me realize how important it is for ECMO survivors to have similar support systems available as they navigate their recovery.

As healthcare professionals, we know how to save lives, but we also need to consider how to help our patients reclaim their lives after they leave our care. This is why I’m interested in finding or creating the resources that ECMO survivors need—counseling, support groups, or simply knowing they’re not alone.

Physical Complications: The Price of Survival

ECMO is a life-saving intervention, but it’s not without its costs. One survivor shared how they suffered multiple strokes and nerve damage following ECMO, which left them with lingering physical challenges. Another survivor, who spent weeks on ECMO while awaiting a heart transplant, became paralyzed from the waist down—a condition that persisted even after a successful transplant. These stories underscore the serious, sometimes permanent, physical toll that ECMO can take.

The Psychological Toll: Struggling with Anxiety and PTSD

The psychological aftermath of ECMO can be just as debilitating as the physical effects. In the support groups, I’ve read about survivors who live with constant fear and anxiety, worried about their health and what the future holds. One story that particularly struck me was of a person who had survived a routine surgery that almost turned fatal, leaving them with deep-seated anxiety about catching a respiratory infection that could endanger their life. Many survivors also reported vivid and terrifying hallucinations and nightmares that continue to haunt them long after their discharge from the hospital.

The Long Road to Healing: Emotional Recovery and Support

Reading these stories has made me realize that there is still much for us to learn about how we can support ECMO survivors after they leave our care. These patients have already endured so much, and the cost and trauma of being on ECMO are immense. Access to mental health resources and support should be a given, not an additional burden. These services need to be free and readily accessible to all survivors, especially those who are elderly, disadvantaged, or non-native speakers who may struggle to access resources as easily as others.

One thing that has become clear to me is the potential value of healthcare professionals joining these survivor groups. By being present in these communities, we can answer questions and offer continued support as survivors navigate their recovery. Understanding their post-ECMO experiences could also help us improve our practice, as it could inform better care practices and follow-up strategies.

A Call to Action for Comprehensive Support

The stories I’ve encountered in these groups have reinforced the importance of comprehensive care for ECMO survivors. The journey to recovery is complex and multifaceted, and survivors need more than just physical healing—they need emotional and psychological support as well. As a healthcare community, we must ensure that all ECMO survivors have access to the resources they need, free of charge, to heal fully and rebuild their lives.

If anyone has ideas or resources they would like to share, please put them in the comments. I’d also love to hear how others have worked with ECMO survivors. Once I return to the U.S., I would like to start something useful for survivors, whether pointing them to available resources or putting together a group of multilingual volunteers—I will keep you informed once a strategy is on the table. If anyone is interested in joining me on this initiative, please message me here on LinkedIn.

For those interested in learning more or connecting with ECMO survivors, here are some groups I’ve encountered: ECMO Survivors Facebook Group, #ECMOSurvivor on Facebook, r/ECMO on Reddit, and ECMO Adults Support Group.

Feel free to leave a comment if you wish to contribute.

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Note: This article reflects my learning journey in ECMO and is intended for educational purposes only. It should not be used as a substitute for professional medical advice or guidance. Always consult with qualified healthcare professionals for clinical decisions and patient care.

Other Links:

Follow me on LinkedIn: Jonathan B. Jung, RRT-NPS

Follow me on X (Twitter) “ECMO 143-Stay Uptodate” List on X

Acknowledgments:

I developed three custom GPTs, “AI ECMO Expert,” “ECMO Specialist Handover Practice,” and “Micro Definitions (MD-GPT),” for specialized research. These tools draw primarily from the ELSO Redbook (6th Edition), the ELSO Specialist Training Manual (4th Edition), various research papers, and articles. Additional research was supported by GPT-4o/o1, Claude 3.5 Sonnet/Opus, and Perplexity. Editing was performed with Grammarly. A.I. images and charts were created using Leonardo AI, DALL-E3 AI Image Generator, Microsoft Designer, and Adobe Express. Content for all articles sourced from Extracorporeal Life Support: The ELSO Red Book, 6th Edition, and ECMO Specialist Training Manual, 4th Edition.

Even without understanding a word, gratitude and respect speak volumes. Recently, I was moved by a video from Bach Mai Hospital in Hanoi, which I had visited during my August travels. Though the narration was in Thai, the story of a family's selfless decision to donate their loved one's organs touched me deeply. Starting at 4:45, the hospital staff’s words to the organ donor show profound reverence—a tribute that reaches beyond language and borders.

On October 16, 2024, a 36-year-old man named Lê Tiến Sơn was brought to Bach Mai Hospital in Hanoi, Vietnam, after suffering a sudden cardiac arrest. Despite the intense efforts of the hospital's medical team to resuscitate him, his prognosis was dire. After a week in intensive care, specialists determined he would not survive. His family was then faced with a profound decision—whether to donate his organs, potentially saving multiple lives.

Moved by a sense of compassion and a wish to help others, his family chose to honor his life through organ donation. This video captures the moment when, with deep gratitude and respect, the operating room staff addressed Mr. Lê Tiến Sơn before proceeding with the organ retrieval. From minute 4:45 to 5:59, the OR staff member speaks directly to Mr. Lê Tiến Sơn, expressing heartfelt gratitude on behalf of the hospital and the patients whose lives would be transformed by this courageous act.

04:48 (translated from Thai to English) "Lê Tiến Sơn, when you fell ill, your family brought you to Bach Mai Hospital for emergency treatment. Our doctors dedicated themselves wholeheartedly to saving you, but sadly, we were powerless to change fate. However, we believe that wherever you are, you will be at peace. Today, we are here with your permission to perform this noble gesture. You were a gentle and compassionate person, always sharing love and helping others. Now you return to Mother Earth, yet it feels as though your heart and life remain with your loved ones. In accordance with your family's wishes, we stand before you and humbly ask permission to donate your heart and part of your body to those suffering from severe illnesses who are desperately seeking life. We believe that, from above, you will watch over this beautiful act with a smile of approval.

Once again, allow us to bow respectfully and honor you. Let us observe a minute of silence."

Their words brought tears to my eyes and truly humbled me. The deep gratitude and respect shown for this individual, who selflessly chose to help others even in passing, is powerful.

When I shared this video with a Chinese anesthetist friend, he mentioned that a similar practice exists in China—before the organ retrieval begins, a brief ceremony and a minute of silence are observed, sometimes even with a family member present. This acknowledgment of the donor's life and sacrifice reflects a universal respect that transcends borders.

Witnessing this reminds me of the incredible dedication within the medical community to honor each donor and support their families in these difficult moments. We could all benefit from understanding this: every donation is a deeply personal, courageous decision that offers hope and life to others.

Thanks for taking the time to read this post.

In November 2020, Maria Young, a healthy 41-year-old, was rushed to Johns Hopkins Hospital with severe COVID-19. Her condition deteriorated quickly, and within hours, doctors placed her on ECMO (Extracorporeal Membrane Oxygenation)—the highest level of life support. Maria remained on ECMO for 69 days, the longest successful run at Johns Hopkins at the time.

During her hospitalization, Maria was fully sedated, and her family could not visit due to COVID-19 restrictions. Still, her mother remained her advocate, calling every day and encouraging her to breathe, even remotely. Nurses held the phone to Maria’s ear while her mother said, "Maria, breathe. I’m breathing with you." Against all odds, Maria regained consciousness in late January 2021, and after months of rehabilitation, she began her recovery.

Watching Maria’s story brought tears to my eyes. I wasn’t working in the medical field during the peak of COVID-19, but I’ve seen how deeply it affected those who were. There’s a shared experience among healthcare professionals who worked during the pandemic—a badge of honor they wear with pride. Maria’s resilience, combined with the dedication of her medical team, not only saved her life but also gave hope to her caregivers.

Inspired by her journey, Maria founded Maria’s Miracle, a nonprofit organization that supports critical care training and provides resources to patients and families navigating ECMO and ICU recovery.

Maria’s Miracle offers a wide array of resources:

• Virtual Support Groups: Weekly support groups for ECMO survivors and caregivers in partnership with the ARDS Alliance.

• Educational Materials: Tools to help families understand ECMO and ICU care, such as a factsheet on ECMO, a glossary of terms, and a link to a guide by the Extracorporeal Life Support Organization (ELSO).

• Book Recommendations: For trauma recovery, critical illness, and coping with COVID-19, including In Shock by Dr. Rana Awdish and Every Deep-Drawn Breath by Dr. Wes Ely.

• Coping Strategies: Insights from Maria’s community on managing the emotional toll of illness.

The nonprofit’s mission also focuses on:

• Funding Advanced Medical Training: Maria’s Miracle supports funding in critical care medicine, including ECMO training.

• Providing Resources for Families: Maria’s Miracle offers guidance to help families navigate the emotional and logistical challenges of extended ICU stays.

Maria’s story highlights the critical role ECMO plays in saving lives. Through her nonprofit, she ensures that others receive the same high level of care she did while also spreading awareness about mental health support for COVID-19 survivors and their families.

How You Can Help

By donating to Maria’s Miracle, you are helping advance critical care worldwide. Donations help fund:

• Training in critical care medicine and ECMO.

• Development of a toolkit for families about ECMO treatment.

• Online resources aimed at debunking health misinformation related to ICU care.

• Awareness campaigns promoting healthy recovery strategies after ICU stays.

Maria’s fight to survive COVID-19 is a powerful testament to human resilience and the dedication of medical professionals. Today, through her nonprofit, Maria continues to give back to the medical community that saved her life while helping families navigate the toughest moments of their lives.

Join the ECMO 143 Learning Journey:

Other Links:

https://bit.ly/ecmo143-youtube

https://bit.ly/ecmo143-fbgroup

https://bit.ly/ecmo143-company

Acknowledgments:

Here is a list of tools and resources that assisted in creating this article and others. I developed three custom GPTs to assist in specialized research: AI ECMO Expert, ECMO Specialist Handover Practice, and Micro Definitions (MD-GPT). These tools were instrumental in gathering and analyzing information from key sources.

Special thanks to the AI platforms and tools that facilitated this research:

• OpenEvidence

• GPT-4o/o1, Claude 3.5 Sonnet/Opus, Perplexity

• Grammarly for editorial and proofreading assistance

• Leonardo AI, DALL-E3 AI Image Generator, Microsoft Designer, and Adobe Express for generating images and visual content

As healthcare professionals, we focus on the critical moments in the ICU, ensuring our patients survive the most dangerous and life-threatening situations. ECMO (Extracorporeal Membrane Oxygenation) is one of the most powerful life-saving interventions available, but the journey for survivors is far from over once they leave the hospital. This reality became clear to me after joining several ECMO survivor support groups earlier this year.

In August, I published an article titled “The Aftermath of ECMO: Beyond Survival,” where I shared my insights on the physical and psychological toll that ECMO survivors experience. While ECMO can save lives, it often leaves survivors facing ongoing challenges—physical complications like strokes and nerve damage and emotional struggles such as PTSD and anxiety.

Today, I’m excited to introduce a new AI-created podcast in which two speakers discuss my article in depth. They discuss the long-term impact of ECMO, the gaps in post-ECMO care, and the importance of support systems for survivors. It’s an honest conversation about the realities of recovery and a call to action for the healthcare community to extend its care beyond the ICU.

Whether you’re an ECMO survivor, a healthcare professional, or simply curious about what happens after life-saving interventions, this video is a must-watch. It reminds us that survival is only the beginning, and the healthcare community must do more to ensure survivors have the resources they need to heal truly.

To watch the podcast:

Read the original article: The Aftermath of ECMO: Beyond Survival

I’ve compiled a list of resources for ECMO survivors and those seeking support. These groups provide essential spaces for connection, understanding, and healing. Many also welcome ECMO practitioners to offer their expertise and support to survivors. By participating in several of these groups, I’ve gained deeper insights into not only what patients experience during their ECMO journey but also how I can improve as a practitioner.

Support Groups for ECMO Survivors:

Facebook: ECMO Support 710+ members

Facebook: ECMO adult survivors and Family Members 2300+ members

Facebook: ECMO Survivors! 3500+ members

Facebook: ECMO Support group for kids and Adults 580+ members

Facebook: Life As An Adult CDH & ECMO Survivor.... Keeping the Faith 350+ members

Facebook: ECMO Warriors - Post-ECMO Survivor group 230+ members

Facebook: ECMO Journey Support Group 830+ members

WhatsApp: ELSO ECMO Patients & Families 110+ members

Reddit: ECMO Survivors and Operators 380+ members

Zoom Meeting: ARDS Support Group This group meets every Tuesday at 7:00 PM Central and includes many members who were on ECMO. If you’d like to join, email Paula at pblonski@ardsalliance.org to receive the Zoom link.

Have Resources or Experiences to Share?

If you know of other valuable resources for ECMO survivors or have personal experiences helping ECMO patients recover, I’d love to hear from you! Please share your thoughts, links, or insights in the comments below. Let’s continue this important conversation and work together to improve the post-ECMO journey for both survivors and practitioners.

Repost and Subscribe. Join the ECMO 143 Learning Journey

Note: This article reflects my learning journey in ECMO and is intended for educational purposes only. It should not be used as a substitute for professional medical advice or guidance. Always consult with qualified healthcare professionals for clinical decisions and patient care.

Other Links:

Follow me on LinkedIn: Jonathan B. Jung, RRT-NPS

Follow me on X (Twitter) “ECMO 143-Stay Uptodate” List on X

Acknowledgments:

I developed three custom GPTs, “AI ECMO Expert,” “ECMO Specialist Handover Practice,” and “Micro Definitions (MD-GPT),” for specialized research. These tools draw primarily from the ELSO Redbook (6th Edition), the ELSO Specialist Training Manual (4th Edition), various research papers, and articles. Additional research was supported by GPT-4o/o1, Claude 3.5 Sonnet/Opus, and Perplexity. Editing was performed with Grammarly. A.I. images and charts were created using Leonardo AI, DALL-E3 AI Image Generator, Microsoft Designer, and Adobe Express. Content for all articles sourced from Extracorporeal Life Support: The ELSO Red Book, 6th Edition, and ECMO Specialist Training Manual, 4th Edition.

I’m introducing Micro Definitions (MD-GPT), my newest custom GPT tool designed to make understanding complex texts easier. As a newcomer to the field of ECMO, I often encountered specialized terms that required frequent lookups, which was time-consuming. To address this, I created MD-GPT, a tool that identifies difficult words, jargon, and abbreviations and quickly provides easy-to-understand definitions. While initially intended for the medical field, this tool is perfect for anyone needing clarity on specialized terms.

How it Works:

1. Paste Text: Copy and paste any term, sentence, paragraph, or entire section with complex terminology.

2. Instant Clarity: MD-GPT parses the text and generates a list of the difficult-to-understand terms with simple, one-sentence definitions.

For example, you can take a complicated medical paragraph and receive a straightforward list of definitions that a 16-year-old could understand.

Example Screenshots:

Find it here: Micro Definitions (MD-GPT). It is completely free to use, no strings attached.

Note: This custom GPT reflects my learning journey in ECMO and is intended for educational purposes only. It should not be used as a substitute for professional medical advice or guidance. Always consult with qualified healthcare professionals for clinical decisions and patient care.

Other Links:

Follow me on LinkedIn: Jonathan B. Jung, RRT-NPS

Follow me on X (Twitter) “ECMO 143-Stay Uptodate” List on X

Acknowledgments:

I developed three custom GPTs, “AI ECMO Expert,” “ECMO Specialist Handover Practice,” and “Micro Definitions (MD-GPT),” for specialized research. These tools draw primarily from the ELSO Redbook (6th Edition), the ELSO Specialist Training Manual (4th Edition), various research papers, and articles. Additional research was supported by GPT-4o/o1, Claude 3.5 Sonnet/Opus, and Perplexity. Editing was performed with Grammarly. A.I. images and charts were created using Leonardo AI, DALL-E3 AI Image Generator, Microsoft Designer, and Adobe Express. Content for all articles sourced from Extracorporeal Life Support: The ELSO Red Book, 6th Edition, and ECMO Specialist Training Manual, 4th Edition.

Extracorporeal Membrane Oxygenation (ECMO) is a critical intervention in modern healthcare, providing life-sustaining support to patients with severe heart and lung dysfunction. However, the intricate interplay between ECMO technology and pharmacotherapy presents significant challenges that require meticulous medication management. As a Respiratory Therapist and novice ECMO specialist, I am expanding my knowledge and understanding of the various medications used in ECMO. This includes fluid balance and medication management, which are new and challenging areas for me. I do a lot of listening and asking questions, even when it feels uncomfortable. Fortunately, my workplace is staffed with highly knowledgeable and experienced colleagues helping my learning journey. Writing this article aids my comprehension of these critical processes. Effective medication management in ECMO is essential for optimizing drug therapy, treating or preventing infections, managing fluid and electrolyte balances, and preventing thrombotic or bleeding complications. This comprehensive guide explores the intricate landscape of medication management in ECMO, equipping healthcare professionals with the knowledge and strategies necessary to navigate this complex setting.

The Multifaceted Roles of Medications in ECMO:

Anticoagulants and Antithrombotics: Anticoagulation is vital in ECMO to prevent clot formation, which can compromise the ECMO circuit and the patient's safety.

• Heparin (Unfractionated Heparin, UFH): Enhances antithrombin III activity, inhibiting thrombin and factor Xa. First-line choice due to ease of reversal and immediate anticoagulant effect.

• Enoxaparin: A low molecular weight heparin that inhibits factor Xa more than IIa, providing more predictable anticoagulation and less risk of heparin-induced thrombocytopenia (HIT).

• Bivalirudin (Angiomax): A direct thrombin inhibitor used in HIT, it provides steady anticoagulation crucial in high-risk ECMO settings.

• Warfarin: Inhibits vitamin K-dependent clotting factors often used for long-term anticoagulation post-ECMO.

Vasopressors and Inotropes: Hemodynamic instability is a common challenge in ECMO patients, necessitating the using vasopressors and inotropes to support blood pressure and cardiac output.

• Norepinephrine (Levophed): This hormone acts on alpha-adrenergic receptors to increase systemic vascular resistance and blood pressure. It is the first-line agent for increasing mean arterial pressure in shock.

• Dobutamine (Dobutrex): Stimulates beta-1 receptors, increasing cardiac contractility and output. It is helpful for low cardiac output states with preserved blood pressure.

• Milrinone (Primacor): A phosphodiesterase-3 inhibitor that increases contractility and induces vasodilation, reducing preload and afterload in heart failure.

• Vasopressin: Enhances vasoconstriction via V1 receptors. It stabilizes blood pressure when other agents are insufficient, especially in septic shock.

Analgesics and Sedatives: Pain management and sedation are essential components of ECMO patient care, particularly those requiring mechanical ventilation.

• Fentanyl: A potent opioid analgesic used for pain control due to minimal hemodynamic effects.

• Midazolam (Versed): A benzodiazepine providing anxiolysis, amnesia, and sedation. Useful for short-term sedation.

• Propofol (Diprivan): Provides sedation without analgesia, allowing rapid titration for neurological assessments.

• Dexmedetomidine (Precedex): An alpha-2 agonist providing sedation and analgesia with minimal respiratory depression, facilitating extubation.

• Hydromorphone (Dilaudid) - A potent opioid analgesic used for managing moderate to severe pain. It is known for its powerful analgesic effect and is less likely to cause nausea compared to morphine.

Antibiotics, Antifungals, and Antivirals:

• Antibiotics

• Antifungals

• Antivirals

Immunosuppressants: Immunosuppressant medications are indispensable for ECMO patients who have undergone organ transplants or have autoimmune conditions.

• Tacrolimus: Binds to FKBP-12, inhibiting calcineurin and preventing T-cell activation, commonly used to avoid transplant rejection.

• Cyclosporine: Similar mechanism to tacrolimus, also used for autoimmune disorders and transplant rejection prevention.

• Mycophenolate mofetil: Inhibits inosine monophosphate dehydrogenase, selectively depleting guanosine nucleotides in lymphocytes.

Diuretics:

• Furosemide (Lasix): A loop diuretic inhibiting sodium reabsorption in the ascending limb of the loop of Henle.

• Bumetanide (Bumex): Another potent loop diuretic, sometimes preferred for significant fluid overload refractory to furosemide.

Other Essential Medications:

• Proton Pump Inhibitors (PPIs)

• Anticonvulsants

• Steroids

Navigating the Complexities of Medication Management in ECMO:

The effective use of medications in ECMO requires a deep understanding of each drug's pharmacodynamics, pharmacokinetics, and potential interactions. Altered drug disposition, drug interactions, and patient variability further complicate the management process, necessitating continuous monitoring and timely adjustments.

Therapeutic Drug Monitoring Therapeutic drug monitoring is crucial for medications with narrow therapeutic windows, such as antibiotics, immunosuppressants, and anticoagulants, as it ensures efficacy while minimizing toxicity.

Monitoring and Adjustment Regular assessment of organ function, electrolyte levels, and clinical responses guide dosage adjustments and help mitigate adverse effects.

Multidisciplinary Collaboration: Optimal medication management in ECMO demands a collaborative effort among ECMO specialists, nurses, pharmacists, and other members of the healthcare team. Regular communication and sharing of expertise facilitate informed decision-making, ensuring that each patient's unique clinical needs are met while minimizing the risks associated with complex pharmacotherapy.

Navigating the intricate landscape of medication management in ECMO requires a comprehensive understanding of the diverse roles played by various drug categories, their mechanisms of action, monitoring requirements, and potential interactions. By mastering this knowledge, ECMO specialists and nurses can optimize patient outcomes, enhance the efficacy of ECMO therapy, and ensure the safety and comfort of critically ill patients undergoing this life-sustaining treatment. Continuous education, multidisciplinary collaboration, and a patient-centric approach are essential to delivering high-quality care in this challenging and dynamic field.

Note: This article reflects my learning journey in ECMO and is intended for educational purposes only. It should not be used as a substitute for professional medical advice or guidance. Always consult with qualified healthcare professionals for clinical decisions and patient care.

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Acknowledgments:

I developed three custom GPTs, “AI ECMO Expert,” “ECMO Specialist Handover Practice,” and “Micro Definitions (MD-GPT),” for specialized research. These tools draw primarily from the ELSO Redbook (6th Edition), the ELSO Specialist Training Manual (4th Edition), various research papers, and articles. Additional research was supported by GPT-4o/o1, Claude 3.5 Sonnet/Opus, and Perplexity. Editing was performed with Grammarly. A.I. images and charts were created using Leonardo AI, DALL-E3 AI Image Generator, Microsoft Designer, and Adobe Express. Content for all articles sourced from Extracorporeal Life Support: The ELSO Red Book, 6th Edition, and ECMO Specialist Training Manual, 4th Edition.