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ECMO (Extracorporeal Membrane Oxygenation)
Global Impact of ECMO
Extracorporeal Membrane Oxygenation (ECMO) is one of a handful of new therapies that have revolutionized medicine in the last 50 years, saving the lives of more than 120,000 patients worldwide since the ECMO community began compiling results.
ECMO is a device that circulates large volumes of a patient’s blood outside his or her body, removes accumulated carbon dioxide, restores depleted oxygen, and returns the enriched blood to the patient so their other organs can survive when the patient’s lungs or heart fail.
For critically ill patients with respiratory and/or cardiac failure, this support therapy has many accomplishments and advantages:
- It has converted previously lethal diseases into survivable ones.
- It has rewritten the natural history of illnesses that were considered death sentences before its advent.
- It has stabilized critically ill patients and enabled the accurate diagnosis and successful treatment of diseases that before would have been fatal within hours of hospital arrival.
- ECMO provides a life-prolonging bridge to heart or lung transplantation when a patient’s own organs fail to recover.
- Because it becomes a part of the patient’s own circulatory system, the ECMO circuit can serve as a portal for devices to supplant other failing organ systems (e.g., dialysis), remove toxic substances from the bloodstream (e.g., hemoperfusion or liver “dialysis”), or facilitate therapies otherwise unavailable without large volume blood removal and return (e.g., whole-blood phototherapy).
Why choose Texas Children’s
Texas Children’s has one of the busiest and most successful ECMO programs in the world. This is thanks to our dedicated team of ECMO specialists, physicians and supporting services who can treat patients with long, complex runs (periods of time a patient is connected to ECMO), including patients who are supported for months at a time. One incredible success story is that of a patient who was discharged from Texas Children’s after being supported on ECMO for more than 380 days before he received his new heart.
Availability. ECMO is available to patients in all critical care settings within Texas Children’s – CICU, PICU, NICU and Adult Congenital Heart Disease ICU. And in partnership with the Kangaroo Crew transport team, it is also available to qualified patients outside Texas Children’s. In some cases, patients already on ECMO at a referring hospital who need further care at Texas Children’s are transported on ECMO by ground or air. When a patient is too sick to risk a transfer off ECMO, the ECMO service will come to the referring hospital, place the patient on ECMO first and then transport that patient on ECMO back to Texas Children’s.
If your child’s care team is discussing ECMO with you, we recommend that you request to be transferred to Texas Children’s ECMO Department. While no center can eliminate all risks, we manage those risks better and more often than children's hospitals that have fewer cases and shorter ECMO runs.
We have a higher volume of patients treated with survival results significantly better than national and international averages in all categories. In 2024, our ECMO team cared for 117 patients with a total of 120 ECMO runs, our largest number ever, while still achieving survival outcomes that exceed national and international averages.
Moreover, with the COVID-19 pandemic and the long associated adult respiratory ECMO runs, we saw a dramatic increase in ECMO hours, especially in 2022. After a drop in hours in 2023, they almost doubled in 2024 to 41,822. This increase means that our professionals continue to acquire and maintain the experience necessary to ensure the highest quality care and outcomes for our patients on ECMO.
| Year | Pump Hours |
| 2019 | 15,631 |
| 2020 | 20,470 |
| 2021 | 22,245 |
| 2022 | 33,775 |
| 2023 | 23,331 |
| 2024 | 41,822 |
Texas Children’s continues to rank among the best centers in the world. Our ECMO Center’s designation as a Center of Excellence at the Platinum level has been renewed for 2025-2028. We first obtained this level in 2021 – the highest level conceded by the Extracorporeal Life Support Organization (ELSO), an international body of ECMO centers dedicated to advancing quality, education and research in ECMO worldwide. We first earned the designation of a Center of Excellence at the Gold Level from ELSO in 2018.
A bridge to transplantation. With Texas Children’s as a heart and lung transplant center, patients under our care who are unable to recover from their primary lung or heart disease can be evaluated for and transplanted if deemed candidates. We have been using ECMO as a bridging strategy for patients with severe end-stage lung disease awaiting lung transplantation for the last 10 years. This technique allows critically ill patients to receive support for extended periods and to become more active and arrive in better condition for the transplant.
Since 2013, our institution has successfully connected 15 patients awaiting lung transplantation to ECMO with the longest run lasting for 207 days. ECMO supports lung function and improves muscle strength in critically ill patients through physical therapy and early ambulation. Ambulatory ECMO can turn the bridge period from a risky waiting time to an opportunity to actively rehabilitate and prevent de-conditioning.
More Texas Children’s ECMO Highlights
Continued development of our profession
For the academic year 2019-20, we inaugurated a 1-year ECMO Fellowship program and successfully recruited the first pediatric subspecialist to this training program. Five fellows have completed the program and received their first faculty appointments, with a sixth and seventh on track to finish in July 2025. The fellows receive immersive experiences in both pediatric and adult ECMO, with extensive ECMO transport experience. They have provided outstanding leadership both within Texas Children’s and outside during their adult ECMO rotations. We can accept up to two fellows per year: one with a background in pediatric critical care (PCC) and one in neonatology. For the 2025 academic year, our eighth fellow with a background in PCC will begin his training.
Texas Children’s Hospital North Austin Campus opened in February 2024 offering a complete array of subspecialty services, including pediatric critical care, neonatology, pediatric and congenital heart surgery, and ECMO. To get the new Austin team ready for opening, physicians and primers from Houston braved a hard freeze to hold a 4-day ECMO workshop for the physicians, surgeons, advanced practice providers, perfusionists and respiratory therapists who make up Austin’s ECMO team.
Education
We have also sponsored a monthly virtual educational conference series on Mechanical Circulatory Support that is open to anyone. We invite local and internationally recognized speakers to share their expertise with attendees from around the world. After suspending this conference in 2024, we are planning to restart it in 2025 and will make the information available on this page.
Because ECMO is both complex and relatively unknown process, ECMO team members have produced two documents to provide families facing ECMO with timely information about the therapy and answer their most pressing questions. Read the ECMO Parent Handbook and The ECMO Parent Guide at Texas Children’s Hospital, available on the Family Resource tab in early 2025.
Quality improvement
We continued growing our extensive quality improvement program and in 2021 inaugurated a monthly quality improvement conference called ECMO Performance Improvement Conference that meets an American College of Surgery requirement to review all ECMO mortalities and major morbidities.
Research and training
In addition to their clinical service, our faculty and staff maintain active research and teaching programs, and have been active in developing novel curricula in Spanish to train new teams developing ECMO programs in Latin America. Our most recent workshop, held in Mexico City in July 2024, brought together a multidisciplinary group of pediatric health professionals to help build an institutional ECMO team at Hospital Infantil Federico Gómez.
Physicians and other ECMO team members, led by thought leaders in the field both at Texas Children’s and across the world, recently completed 2-year examination of priorities in our field that will help set the agenda for both ECMO research and clinical innovation in the decades to come.
On July 20, 2022, we established the first-ever ECMO Specialists’ Day at Texas Children’s Hospital. The goal of the day was to recognize the tremendous efforts put forth by our ECMO specialists.
Activities included presentations by a retired cardiac surgeon, Dean McKenzie, MD, who paid great respect to the importance of ECMO specialists, as he shared his views on his unique experience as both an ECMO surgeon and ECMO patient prior to his own lung transplant, and by perfusionist Mary Claire McGarry who talked about inaugurating the ECMO specialist program at Texas Children’s.
In 2023, we had a quiet recognition day for our ECMO specialists in December. Things picked back up in 2024 when we joined forces with institutions in Maine, Oregon, Colorado and Indiana to celebrate ECMO Specialists’ Appreciation Week from April 29-May 3, 2024. We plan to convert this week of recognition into a national and international event recognized by the international ECMO organization, Extracorporeal Life Support Organization (ELSO).
