Extracorporeal Life Support Program (ECLS)
When your child’s heart or lungs cannot function unassisted or with medicines or mechanical ventilation, extracorporeal life support (ECLS) can provide support long enough for these organs can heal and take over. Our team of experts providing ECLS includes cardiopulmonary perfusionists, cardiac surgeons, general surgeons, intensivists, neonatologists and nurses or respiratory therapists with advanced ECMO training.
How does ECLS help?
Extracorporeal membrane oxygenation (ECMO) is a form of heart-lung bypass used to circulate blood outside of the body when a child’s heart or lungs fail to function properly or need to rest.
Extracorporeal membrane oxygenation
There are two types of ECMO:
- Venoarterial ECMO. This type of ECMO does the work of your child’s heart and lungs. A thin tube (cannula) is placed in the heart’s right atrium. Oxygen-poor blood is drawn through this tube and into a bypass machine that removes excess carbon dioxide and adds oxygen. Then the machine returns the oxygen-rich blood to your child’s body through another cannula that goes into the aorta.
- Venovenous ECMO. This type of ECMO does the work of your child’s lungs and gives some support to the heart as well. It is like the other type of ECMO, except that the oxygen-rich blood is returned to the right atrium or to the inferior vena cava (instead of the aorta, as in the first type of ECMO); your child’s heart is still pumping blood to the lungs.
When a child needs CPR because of cardiac arrest, we provide ECMO along with CPR. This approach, called ECMO CPR (ECPR), may help save more children’s lives.
When a child is undergoing ECMO in another city and needs to come to Seattle Children’s for a transplant or other care, we can transport them without interrupting ECMO treatment.
Ventricular assist device (VAD)
A ventricular assist device (VAD) is a mechanical pump a surgeon implants inside or outside your child’s chest and connects to the heart during open-heart surgery. A left ventricle device helps the heart pump oxygen-rich blood to the rest of the body. A right ventricle device helps pump oxygen-poor blood to the lungs. Some patients need a device that does both. A VAD can be used for patients waiting for a heart transplant or for patients whose heart muscles need to strengthen.
Seattle Children’s offers many types of VADs. Deciding which type might be best depends on your child’s age and health condition.
- Berlin Heart. This device, designed for children, can support the left or right ventricle, or both, in a child of any age. It sits outside the body and is connected to the heart with tubes.
- HeartMate II. This device supports the left ventricle and is used in adolescents, teens and adults. The HeartMate is placed inside your child’s chest and is connected to the heart and to a wire that comes out through the skin to a control device and power source. Patients can be discharged home with the HeartMate II.
- CentriMag centrifugal pump. This device is used on a short-term basis in teens to provide support until another device can be placed, or until the patient recovers. The CentriMag lies outside the body and can be used for either left- or right-side heart support.
- SynCardia Total Artificial Heart. This device supports the left and right ventricles and is used in teens and adults.
What’s special about ECLS at Seattle Children’s?
Seattle Children’s has the largest ECLS program for babies, children and teens in the Northwest.
- We’ve been named a Center of Excellence by the Extracorporeal Life Support Organization (ELSO), a group of healthcare professionals and scientists from around the world who work to advance care. Drs. Michael McMullan and Thomas V. Brogan work closely with ELSO.
- Surgeries for some high-risk conditions can be performed at Seattle Children’s only because we can use ECLS for a time after surgery, to temporarily sustain heart function in children who would not be able to survive and recover without it.
- Our doctors conduct research to understand the factors that help children do better on ECLS. This research helps our team refine and improve treatment plans as we seek to better support patients and reduce complications. Seattle Children’s was one of the original 10 medical centers chosen to take part in a nationwide U.S. Food and Drug Administration (FDA) study testing the Berlin Heart; the device won FDA approval in 2011.
Who’s on the team?
Dr. McMullan is director of Mechanical Cardiac Support and ECLS Services. Dr. Brogan is associate director of ECMO Services. Dr. Robert L. Mazor is associate director of Cardiac ECMO.
Providers involved in ECLS include:
- Cardiac surgeons
- General surgeons
- Nurses or respiratory therapists with advanced ECMO training
- Cardiopulmonary perfusionists (read more about the perfusionists on our Heart Center team)
Seattle Children’s ECMO nurses or respiratory therapists are specialists with advanced ECMO training. These specialists monitor a child’s ECMO pump 24 hours a day.
In 2013, Seattle Children’s started the Natalie Razore Rockstar ECMO Fellowship to provide advanced training for doctors working in this critical area of care.