CPT® Code 33947

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; initiation, veno-arterial

Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) are terms that refer to advanced medical procedures designed to provide long-term support for patients experiencing severe heart and lung failure. These procedures typically last from three to ten days and involve the circulation of blood outside the body through an artificial lung, which oxygenates the blood before returning it to the patient's bloodstream. In the case of veno-venous (V-V) ECMO/ECLS, blood is drawn from a large central vein, oxygenated, and then returned to the venous system. Conversely, veno-arterial (V-A) ECMO/ECLS involves drawing venous blood from a large central vein and returning it to a major artery after it has been oxygenated. The initiation of ECMO/ECLS is a complex process that requires a thorough evaluation of the patient's condition, including various diagnostic tests such as laboratory analyses, X-rays, cardiograms or echocardiograms, and neurological assessments, particularly in neonates. Informed consent from the patient or their family is a critical step in this process. The setup of the ECMO equipment, which includes the ECMO pump, anticoagulation testing (ACT) machine, tubing, and ECMO bed, is essential before the procedure can commence. Medications and blood products are also prepared in advance. Once the ECMO circuit is ready, and the medical team is in position, the cannulation of the vessels can occur, allowing for the initiation of ECMO/ECLS therapy. This procedure can be performed by qualified healthcare professionals such as neonatologists, pediatric intensivists, surgeons, or interventional cardiologists, with continuous monitoring provided by a perfusion specialist to ensure patient safety and efficacy of the treatment.