ECMO

At 4:35am we were awakened to a call we definitely didn't see coming.  Makenna's stats had been dropping all night and no matter what intervention they tried, her poor little lungs just weren't big enough or strong enough to sustain her any longer.  After many efforts, Dr. Kays made the decision to place Makenna on ECMO.

What is ECMO?
ECMO is a lung and heart by-pass machine that can be used for a long period of time.  There are two cannulas that are surgically connected to blood vessels in Makenna's neck (the blood vessels connect to her heart/bloodstream).  The cannulas have tubes, one tube takes the blood from Makenna's body and enters a machine that adds oxygen to the blood and removes carbon dioxide, then the blood travels back to her body through another tube.  This lets her lungs and her heart both rest.  There are a lot of risks involved in this process including blood clots (that can lead to strokes/embolisms) and internal bleeding (they give her blood thinners to reduce the risk of clots).

Because ECMO is so risky they have an ECMO tech assigned to the machine at all times (day and night).  Their job is to watch the numbers, check for clots every hour, and remove clots when they form (along with lots of other "medical things" I don't understand!). 

The ECMO tech can also control how fast/slow the blood flows through the tubes.  They started Makenna at a flow of 300 (I believe it goes as fast as 400).  The machine was doing 100% of the "breathing" for her so her lungs could rest; however, she is still hooked up to the ventilator so that her lungs will continue to inflate/deflate.  This helps them practice breathing and keeps her lungs from collapsing.  To be ready to come off ECMO she will need her flow to be around 150.  They will slowly lower her setting as her stats indicate she can handle it.

Surgery: 
Once we received the call that she needed to go on ECMO we immediately went to the NICU to see her.  We were still sleeping in the hospital, so it didn't take long.  When we got there we talked to one of the doctors and she said that Makenna was doing so poorly they need to get her on ECMO immediately or she wouldn't make it. They said hooking up to ECMO would take about an hour and since she was being prepped for surgery we weren't able to see her.  We went back to my hospital room and began what felt like the longest wait of our lives.  4 hours later we finally received the news that Makenna's surgery went well and to quote Dr. Kays "This kid likes ECMO."  He also said that only time will tell how long she will need to be on ECMO.  It could be a little as a week or as much as 3 weeks and that her surgery most likely wouldn't happen until she was off ECMO because the blood thinners make surgery even more risky. 

The ECMO machine (the tubes are red because of blood)

Makenna after surgery