We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
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The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
ECMO is a technique used in critical patients suffering from extremely serious respiratory and/or cardiovascular diseases where conventional life support is insufficient. The machine temporarily replaces lung or heart function, enabling the organs to rest while the underlying illness is treated.
The machine removes blood through a thick tube inserted into a major vein and transfers it to a centrifugal pump. The pump pushes it through an oxygenator, where oxygen is added and carbon dioxide removed. Subsequently, it is reintroduced into the patient’s body. If this is done through another vein, it is known as veno-venous (VV) ECMO and provides respiratory support. Where it is done via an artery, this is known as veno-arterial (VA) ECMO and provides support for both the heart and lungs.
ECMO is not a treatment per se but rather a support mechanism. It optimises organ recovery but does not resolve the underlying problem. In fact, one of the reasons to use the procedure is its reversibility for patients. The system is highly effective in replacing vital organ function. However, it is currently a last option for a specific patient group given its complex nature and associated risks, such as bleeding, thrombosis and infection.
Regardless of the support strategy chosen, this is a highly complex technique associated with a high risk of serious complications. That is why, in order to ensure excellent care, a well-organised programme is required, with optimal material and sufficient numbers of properly trained staff. Cases need to be clustered at leading centres and units with the necessary resources and material to ensure effectiveness, as well as a highly trained multidisciplinary team.
The Extracorporeal Life Support Organization (ELSO) is the benchmark international scientific association for ECMO. It establishes care and organisational guidelines, coordinates teaching activities and promotes research in the field. The organisation has a multi-centre database with information on over 200,000 patients. Although patients receive optimal care through ECMO with excellent survival rates, they often have later side effects due to the seriousness of their illness and the intense nature of their care, both during ECMO and with prior treatment.
Vall d’Hebron is home to two ECMO programmes. One is for adult patients and led by Dr Jordi Riera, and the other is for children and new-born patients, led by Dr Joan Balcells.
Our programmes follow ELSO guidelines at all levels, from lifelong, multidisciplinary and skill-based training for ECMO teams to filling in records for continuous assessment, as well as optimised protocols that align with our context and setting.
Our programmes take a long-term outlook, focused on getting patients back to their daily lives with maximum functional recovery. In this sense, we prioritise minimal deep sedation and safe early physical rehabilitation, even where recovery of the failed organ is still ongoing. ECMO support makes this possible by substituting heart and lung functions. Moreover, patients are able to directly interact with professionals and family members.
Veno-Arterial (VA) and Veno-Venous (VV):
The VA option provides heart and lung support by taking over organ functions. It is used when there is a cardiorespiratory problem, such as a heart attack or myocarditis (inflammation). The VV option is used to provide respiratory support and takes over lung function. It is used where there is a breathing issue, such as pneumonia or an acute blockage in the airways.
Peripheral or central line:
Patients are normally connected to an ECMO machine through cannulae (thick tubes) in the neck or groin. This is known as a peripheral line. At times, the machine needs to be directly connected to a patient’s heart or very close to the heart through the chest. This is known as a central line.
Special scenarios:
ECMO is an effective system but can pose major risks for patients. In terms of frequency and potential seriousness, these risks include bleeding and infection.
Bleeding is due to the fact that patients are often treated with blood thinners. Infection is due to receiving highly invasive therapy and the severity of the illness.
In order to minimise these risks, it is essential to have a properly trained multidisciplinary ECMO team, cluster ECMO cases and resources, and ensure robust records comparable to other consolidated external records.
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