ECMO may be considered when a newborn has severe heart or lung failure that is not improving with conventional treatment and is expected to be reversible. Common reasons include meconium aspiration syndrome, persistent pulmonary hypertension of the newborn, severe sepsis or pneumonia, and certain congenital heart or lung conditions.
Understanding Neonatal ECMO and Related Birth Injuries
Extracorporeal membrane oxygenation (ECMO) is the most intensive form of life support available for newborns. It takes over the work of the lungs, or the heart and lungs, when a baby’s own organs are failing. If your baby needed ECMO, understanding why it became necessary and how the treatment was managed can help your family learn whether a preventable birth injury or medical error played a role.
What is neonatal ECMO?
ECMO is used for newborns with severe heart or lung failure that is expected to improve with time and treatment, when a ventilator, medications, and other intensive care are not enough. The baby’s blood is routed through a machine outside the body that adds oxygen and removes carbon dioxide before returning it to the baby.
There are two main forms. Venovenous (VV) ECMO supports the lungs only, while venoarterial (VA) ECMO supports both the heart and lungs. ECMO does not cure the underlying illness. It buys time while the medical team treats the condition and gives the baby’s heart or lungs a chance to recover.
ECMO is only available at specialized centers. When a baby is deteriorating at a hospital that does not offer it, the timing of the decision to transfer can matter a great deal.
What conditions can lead a newborn to need ECMO?
Neonatal ECMO is most often considered when a baby has severe heart or lung failure from a condition that may improve with treatment. Conditions relevant to a birth injury review include:
Meconium aspiration syndrome (MAS), in which the baby inhales meconium before or during birth, causing blocked airways, lung inflammation, and high blood pressure in the lungs
Persistent pulmonary hypertension of the newborn (PPHN), in which blood cannot flow properly through the lungs, leading to dangerously low oxygen levels
Severe newborn infection, sepsis, or pneumonia that progresses to breathing or circulatory failure
Severe heart or lung failure occurring alongside hypoxic-ischemic encephalopathy (HIE) or significant oxygen deprivation around birth
Congenital conditions, including congenital diaphragmatic hernia or certain heart defects, that can cause severe heart or lung failure even when no medical error occurred
When ECMO-related care may be medical malpractice
Not every newborn who needs ECMO experienced medical malpractice. Severe breathing and heart conditions can develop even when prenatal, labor and delivery, resuscitation, and NICU care are appropriate. A malpractice review looks at two separate questions: whether a preventable breakdown in care caused or worsened the condition that made ECMO necessary, and whether an avoidable injury occurred while ECMO was being provided.
The following circumstances may point to negligence in the care leading up to ECMO:
- Failing to recognize or respond appropriately to concerning fetal heart rate patterns or other signs that the baby was not tolerating labor
- Delaying delivery when the baby was showing signs of ongoing oxygen deprivation that may have contributed to worsening heart or lung failure
- Failing to identify or treat a maternal or newborn infection in time, allowing it to progress to severe sepsis, pneumonia, or shock
- Failing to provide timely and appropriate resuscitation or breathing and circulatory support after birth
- Failing to recognize and escalate treatment for worsening MAS, PPHN, or other progressive breathing failure
- Delaying transfer to an ECMO center, or delaying an ECMO evaluation, when a baby was not improving with conventional treatment
ECMO also carries recognized risks, including bleeding, clotting, brain injury, infection, damage to red blood cells, and equipment problems. A complication alone does not mean the ECMO team was negligent. The following scenarios may point to negligence if expert review shows that monitoring, equipment management, blood-thinning medication, or the response to a complication fell below the accepted standard of care:
- Improper placement of the ECMO tubes (cannulas), or failure to notice that a tube has shifted, resulting in inadequate blood flow or injury to a blood vessel or the heart
- Failing to detect or respond to air in the circuit, clotting in the circuit, loss of flow, or a mechanical problem
- Failing to evaluate or respond to new neurologic signs, including signs of bleeding in the brain, stroke, or seizures
- Lapses in sterile technique or line care that contribute to a preventable infection
- Failing to respond promptly to worsening oxygen levels, poor circulation, or other evidence of a serious complication
Wais, Vogelstein, Forman, Koch & Norman, LLC works with medical experts to review fetal monitoring, delivery records, resuscitation records, NICU and ECMO records, imaging, laboratory data, and the timing of key clinical decisions to assess whether preventable errors contributed to a child’s injury.
Treatment, recovery, and long-term outlook
ECMO supports a newborn while the underlying condition is treated. Depending on the diagnosis, care may also include a ventilator, medications to support blood pressure or heart function, treatment for pulmonary hypertension, antibiotics for infection, and other intensive therapies.
During ECMO, the medical team monitors oxygen levels, circulation, the ECMO circuit, blood-thinning medication, bleeding and clotting, and the baby’s neurologic status. When the heart or lungs recover enough, the team gradually reduces support and, when appropriate, removes the tubes.
Long-term outlook depends on why ECMO was needed, how sick the baby was beforehand, and whether brain injury or other complications occurred before, during, or after treatment. Because some effects may not be apparent at discharge, children who survive neonatal ECMO generally benefit from structured medical and developmental follow-up as they grow.
Frequently Asked Questions
Common questions about neonatal ECMO and birth injuries.
When a baby needs ECMO, it is understandable to have questions about what led to such intensive treatment and whether anything could have been prevented.
What conditions can cause a newborn to need ECMO?
Is needing ECMO always caused by medical malpractice?
No. Many newborns need ECMO because of severe illness or congenital conditions that can arise despite appropriate care. Malpractice may become a concern when the evidence suggests that a preventable error caused or worsened the condition that led to ECMO, or that an avoidable injury occurred during ECMO care.
How can families find out whether a birth injury contributed to the need for ECMO?
The answer usually requires a timeline-based review of the labor and delivery records, fetal heart rate tracings, cord blood gases when available, newborn resuscitation records, imaging, infection testing, NICU records, and ECMO records. Medical experts can evaluate whether the baby’s condition developed despite appropriate care or whether a delay, missed warning sign, or other preventable error may have contributed.
How long do families have to file a claim involving ECMO injuries?
The deadline, or statute of limitations, depends on the state where the care occurred and on who is bringing the claim. A claim for harm to the mother often follows a different timeline than a claim brought on behalf of a child, and many states allow more time for a child’s claim. The deadline may also depend on when the injury was discovered, the provider involved, and whether special notice requirements apply. Because these rules vary and can be shorter than families expect, speaking with an attorney promptly can help you understand the time limits that apply to your situation.
