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What is Extra Corporeal Life Support

• Introduction
• What is ECLS?
• How does it work?
• What are the risks?
• How long will my child be on ECLS?
• Pain
• Things that may help from other parents & staff
• Contact

Introduction

Welcome to the Royal Children’s Hospital Extra Corporeal Life Support (ECLS) web page. ECLS commenced at The Royal Children’s Hospital in 1988 with Extra Corporeal Membrane Oxygenation (ECMO), and was followed a year later with Ventricular Assist Device (VAD). Since that time 426 babies and children have been supported with ECLS. The Royal Children’s Hospital is the national centre, caring for babies and children who may require ECLS from all of Australia.The information on this page is available as a brochure, link at end of page.For more detailed information please contact ECLS co-ordinator. We are members of the Extracorporeal Life Support Organization -ELSO,a world wide consortium of healthcare professionals that report all data to a central registry.

What is ECLS?

Your child’s condition remains critical despite maximum treatment, it has become necessary to consider placing your child on ECLS.
We place children on ECLS when their heart and/or lungs are not able to provide the body with enough blood flow and oxygen despite standard intensive care support. During ECMO (extracorporeal membrane oxygenation) the heart and lungs are bypassed and the blood is oxygenated outside the body(extracorporeal) by an artificial lung and circulates with the help of an external pump, allowing the heart and lungs to rest. This is similar to the heart-lung bypass machine used during open heart surgery.Jostra console and Quadrox oxygenator equipment are used for ECLS.

VAD(ventricular assist device) is a form of ECLS where only the heart is supported and not the lungs. VAD can be used to support the main pumping chamber(s) of the heart if they are not pumping sufficiently well.

It is important to note that ECLS does not cure anything. It provides support for recovery.
However,we believe the condition your child has is potentially reversible and if the heart and lungs are rested recovery is possible.There have been thousands of ECLS cases worldwide and we have been using ECLS at the Royal Children’s Hospital since 1988.

How does it work?

A cardiac (heart) surgeon will place two tubes(cannula) into major blood vessels in the neck, groin or chest. These tubes are then connect to the ECMO or VAD machine,Jostra brand of console used.Blood passes from the veins into the tubing circuit and through the oxygenator,Quadrox brand(which does the work of the lungs) and is pumped back into the circulation via the child's blood vessels.

Will my child be normal if he/she survives?

Although it is complicated technology with some risks, many of our ECLS survivors go on to develop normally.

The team:

This will include specially trained nurses who will do all the bedside care around the clock and can help with your involvement in caring for your child . The ECLS nurses are specially trained to troubleshoot the mechanical circuit.The team also includes perfusionists,surgeons and Intensive care doctors,all closely monitoring your child’s every need.

What are the risks?

ECLS is a life saving proceure,which carries important risks.However,in your child’s case,we feel strongly that the benefits outweigh the risks.It is important to prevent blood in the circuit from clotting ,we will do this with a drug called Heparin, which thins the blood. Heparin increases the risk of bleeding from the tube sites,surgical wounds, and internally. Internal bleeding can affect the brain and stomach. Blood products will need to be given routinely every day ,some times in large volumes.Another important risk is infection, which we try to minimise using sterile techniques where possible. Although every safety measure is taken, the mechanical circuit can occasionally malfunction in various ways. These problems include blood clots forming, air bubbles in the circuit, and failure of the circuit or oxygenator. If any of these problems occur, we will act immediately to keep your child stable and place them back on ECLS support as soon as possible.

How long will my child be on ECLS?

This varies with the original condition,some illnesses need ECLS for longer than others,in general ECLSis needed for 5- 35 days.With signs of improvement,your child’s own heart and lungs will be allowed to do more of the work(weaning).When we feel that your child is ready to come off ECLS support, the tubes will be removed from the vessels by the surgeons. Your child may well require intensive care for some time after coming off ECLS .

Pain

Being on ECLS is not painful in itself, and we allow children to be as alert as possible without subjecting them to pain or discomfort. Cannula safety is paramount so movement is restricted.

Glossary - Some terms you will hear:

• A.C.T. - Activated Clotting Time: a blood test taken hourly to see how long it takes to form a blood clot
• ANTIBIOTIC - A drug used to prevent or eliminate infection
• AORTA - A large artery in the chest
• ARTERIAL BLOOD GAS (ABG) - A blood sample taken from the line in the arterial blood vessel to test for oxygen and other elements
• CANNULA - A plastic tube placed in a blood vessle to drain the blood in to or out of the body
• CAROTID ARTERY - A large artery in the neck
• CHEST DRAIN - A tube placed in the space between the lung and chest wall to let fluid and/or air/blood out in to a suction chamber at the bed side
• CIRCUIT - the tubing and pump of the ECLS
• COAG - Coagulation blood test to determin the clotting state.
• DECANNULATE - To remove the cannula at completion of ECLS
• ECMO - Extra Corporeal Membrane Oxygenation,bypassing the heart and lungs to the machine to pump and add oxygen to the blood
• ECHO - ultrasound examination of the heart
• ECLS - Extra Corporeal Life Support-this tem covers all forms of assist therapy including ECMO and VAD
• ECG - Electro Cardio Graph- electrical tracing of the hearts conductivity pattern.May be effected by need for electrolytes such as potassium. Gives a sign of how well the heart is working
• EEG - Electroencephalogram-recording of the brains electrical activity
• HEPARIN - Drug used to prevent the blood from clotting
• INTRACRANIAL HAEMORRHAGE - abnormal bleed in the brain
• INOTROPE - Drugs used to make the heart beat more strongly.
• OXYGENATOR - Part of the ECMO circuit that adds oxygen to the blood and removes carbon dioxide as blood flows over the membrane ,Quadrox brand used.
• PACEMAKER - An temporary external battery box to stimulate or track the heart rate.
• PANC/VEC - Pancuronium or vecuronium, drugs used to stop child from moving,called muscle relaxants
• PERFUSIONIST - A specialist in the heart/lung bypass machinery and care
• PLATELETS - Blood cells that help with clotting
• PUMP - The device used to circulate the blood through the circuit and back to the patient. Jostra or Biomedicus type used.
• SUCTION - Usually a thin catheter passed down the breathing tube to clear secretions from the lungs
• STERNUM/STERNAL - Breast bone area of the chest often this area is open with an opaque dressing over it.
• VAD - Ventrcicular Assist Device-this can be left or right ventricular support allowing this chamber of the heart to rest and the external pump does its work.
• VENTILATOR - Breathing machine used to put oxygen in to the lungs. VIP,JET,EVITA and HFOV types used
• WEANING - child’s own heart and lungs allowed to do more work and less support from the circuit
• X-RAY - Radiograph taken at least daily of the chest to check on cannula, tube placement and the clarity of the lungs.

Things that may help from other parents & staff

• Keep your thoughts positive! Talk about your concerns, Social workers & Chaplains are readily available to help
• Keep a diary of your child’s daily events, include your thoughts, photos and visitors etc.
• Ask the staff as many questions as you like rather than worry, write them down or make a list of things to ask
• Hold your child’s hand and talk to them or play music, bring in their own blanket and toys to personalise their bed spot.
• If you want to breast feed your child, try and express milk for it’s the one thing you alone can do
• It is vital for you to to get plenty of rest and eat and drink well as you need energy to cope too
• ‘It is easy to see things out of perspective when you’re exhausted and worried’
• Try and take a walk outside to get some fresh air every day
• Ask staff about photos for emailing and getting on disk to keep

Contact Us

• Download the brochure (PDF 284 KB)