Is ECMO considered critical care? A definitive guide

September 21, 2025 •

4 min read

According to the Extracorporeal Life Support Organization (ELSO), ECMO is a highly specialized, advanced therapy used to treat life-threatening heart or lung failure. Due to its complexity, constant monitoring requirements, and use on the most unstable patients, the answer to 'Is ECMO considered critical care?' is a resounding yes.

Quick Summary

ECMO is an advanced form of life support used exclusively within a critical care setting, typically the Intensive Care Unit (ICU), to temporarily take over the function of failing lungs and/or heart.

Key Points

Definition: ECMO is an advanced life support system that temporarily takes over the function of a patient's failing heart and/or lungs, allowing them to rest.
High-Level Monitoring: Due to its complexity and the severity of the patient's condition, ECMO requires continuous, specialized monitoring in an Intensive Care Unit (ICU).
Specialized Team: The management of ECMO involves a highly trained, multidisciplinary team, including intensivists, surgeons, perfusionists, and specialized nurses.
Significant Risks: ECMO carries a high risk of complications, such as bleeding, blood clots, and infection, which must be carefully managed in the critical care setting.
Bridge to Recovery: The therapy acts as a bridge to either organ recovery, transplant, or other definitive treatments, not as a cure for the underlying condition.
Distinct from Ventilator: Unlike a ventilator that only assists breathing, ECMO handles gas exchange outside the body and can provide heart support (VA-ECMO) or lung support (VV-ECMO).
Resource Intensive: ECMO is a resource-intensive therapy, both in terms of equipment and skilled personnel, making it exclusive to major medical centers.

What is ECMO?

Extracorporeal membrane oxygenation, or ECMO, is a treatment that uses an external machine to temporarily perform the work of a patient's lungs and/or heart. It is an advanced form of life support reserved for critically ill patients when conventional life-support measures, such as mechanical ventilation, have failed. By oxygenating the blood outside the body, ECMO allows the patient's own organs to rest and heal from the underlying illness or injury.

There are two main types of ECMO, determined by the patient's specific needs:

Veno-Venous (VV) ECMO: This type of support is for patients experiencing severe lung failure but whose heart function is still adequate. Deoxygenated blood is drawn from a large vein, passed through the ECMO machine for oxygenation, and then returned to a vein. The patient's native heart continues to pump the oxygenated blood throughout the body.
Veno-Arterial (VA) ECMO: This provides support for both heart and lung failure. Blood is drained from a large vein, oxygenated by the machine, and then pumped back into a large artery. This process bypasses both the heart and lungs, allowing them to rest completely.

Why is ECMO a critical care modality?

Placing a patient on ECMO fundamentally requires intensive care. This is not a procedure performed in a standard hospital ward. The reasons for this are numerous and rooted in the high-stakes, high-acuity nature of the therapy.

Constant, High-Level Monitoring

ECMO patients are among the sickest in the hospital and require continuous, specialized monitoring. This includes constant assessment of the patient's vitals, lab work (including blood gases to check oxygenation), and the ECMO circuit itself. Any change in the patient's status or the machine's function can have immediate and severe consequences. This necessitates a high patient-to-staff ratio, with nurses and specialists dedicated solely to the patient's care.

A Multidisciplinary Team Effort

An ECMO program is never run by a single person; it requires a highly trained, multidisciplinary team. This team includes intensivists (ICU doctors), cardiothoracic or vascular surgeons who place the cannulas, highly trained ECMO specialist nurses and respiratory therapists who manage the machine, and perfusionists. This collaborative approach ensures that all aspects of the patient's care are managed by experts, from the technical settings of the machine to the overall medical strategy.

The Need for Specialized Resources

Only large medical centers with the necessary equipment, facilities, and trained personnel can offer ECMO therapy. The resources required are substantial and not available at every hospital. This centralization of care ensures that patients receiving ECMO have access to the highest level of medical technology and expertise.

Potential complications and risks

While ECMO can be life-saving, it is a high-risk procedure with potential complications that require critical care vigilance.

Bleeding: The need for blood-thinning medication (anticoagulants) to prevent clots in the ECMO circuit increases the risk of bleeding. This can occur at the cannulation sites or internally, including in the brain, and is a major concern.
Blood Clots: Paradoxically, despite using blood thinners, clots can still form within the circuit or in the patient's blood vessels, which could lead to a stroke or other serious complications.
Infection: Patients on ECMO are immunocompromised and have multiple entry points for infection due to the cannulas and invasive monitoring lines.
Mechanical Failure: The ECMO circuit itself can fail, which necessitates an immediate and highly coordinated response from the medical team.

ECMO vs. a mechanical ventilator

While both are life-support measures, ECMO is a more advanced and intensive form of therapy than a standard mechanical ventilator.


Feature	Mechanical Ventilator	ECMO
Function	Pushes air into and out of the lungs to assist or take over breathing.	Circulates and oxygenates the blood outside the body, replacing heart and/or lung function.
Level of Support	Primarily respiratory support.	Full cardiopulmonary bypass (VA-ECMO) or advanced respiratory support (VV-ECMO).
Patient Condition	Used for respiratory failure.	Reserved for severe, life-threatening heart and/or lung failure refractory to conventional treatments, including ventilation.
Organ Rest	Lungs are still used but with reduced pressure and volume.	Allows the heart and/or lungs to rest completely and heal.
Complexity	Standard ICU care.	Highly specialized, resource-intensive critical care.

The journey through ECMO

For patients and their families, the ECMO journey can be long and challenging, lasting anywhere from a few days to weeks or even months. The ultimate goal is to wean the patient off ECMO as their organs recover. The weaning process is gradual and closely monitored. For those who successfully come off ECMO, the recovery process is often extensive, involving physical therapy and psychological support.

As a life-sustaining treatment, ECMO is not a cure for the underlying disease. In some tragic cases, if the patient’s condition does not improve, the medical team will have difficult discussions with the family about end-of-life options. The decision to initiate and withdraw ECMO involves complex ethical considerations, often guided by institutional protocols and ethics committees, balancing the potential for recovery against the burden of care and prognosis.

For more information on patient expectations, visit the official website for the Extracorporeal Life Support Organization, an authoritative resource for clinicians and patients: ELSO.org.

Conclusion

In conclusion, ECMO is unequivocally a critical care procedure due to its immense complexity, reliance on highly trained personnel, and application in life-or-death situations. It represents the pinnacle of advanced life support, offering a last chance for recovery for patients with the most severe cardiopulmonary failure. Its very nature demands the constant, vigilant, and specialized environment of an intensive care unit.

Frequently Asked Questions

ECMO is reserved for critical care settings, such as the ICU, because it is an extremely complex and high-risk procedure. Patients on ECMO are the sickest in the hospital and require 24/7 monitoring by a highly trained, multidisciplinary team of specialists.

A ventilator helps a patient breathe by moving air in and out of the lungs. ECMO is a much more advanced therapy that circulates the blood through an external machine to remove carbon dioxide and add oxygen, temporarily performing the function of the heart and/or lungs entirely. It is often used when a ventilator is not enough.

Conditions that may require ECMO include severe heart failure (cardiogenic shock), severe lung failure (like Acute Respiratory Distress Syndrome, ARDS), severe pneumonia, pulmonary embolism, or as a bridge to a heart or lung transplant.

The duration varies greatly depending on the patient's condition and recovery, ranging from a few days to several weeks or even months. The goal is to wean the patient off ECMO as soon as their organs have recovered enough to function on their own.

Major risks include bleeding (due to required blood thinners), blood clots, infection, limb complications from cannula placement, and potential damage to blood vessels or organs. All of these require constant vigilance from the critical care team.

The team is multidisciplinary and includes intensivists, cardiothoracic surgeons, perfusionists (specialists who run the machine), ECMO specialist nurses, respiratory therapists, and others depending on the patient's needs.

No, ECMO is a life-sustaining support therapy, not a cure. It provides time for the patient's heart and/or lungs to rest and for medical treatments to address the underlying illness, giving the patient a chance to recover.

While many patients are sedated, particularly during the initial stages, it is sometimes possible for patients on VV-ECMO to be awake and even participate in physical therapy, depending on their condition and stability. VA-ECMO patients are more commonly sedated due to the greater level of support required.