Position paper for the organization of ECMO programs for cardiac failure in adults
Journal
Intensive Care Medicine
Journal Volume
44
Journal Issue
6
Pages
717-729
Date Issued
2018
Author(s)
Abrams D.
Garan A.R.
Abdelbary A.
Bacchetta M.
Bartlett R.H.
Beck J.
Belohlavek J.
Fan E.
Ferguson N.D.
Fowles J.-A.
Fraser J.
Gong M.
Hassan I.F.
Hodgson C.
Hou X.
Hryniewicz K.
Ichiba S.
Jakobleff W.A.
Lorusso R.
MacLaren G.
McGuinness S.
Mueller T.
Park P.K.
Peek G.
Pellegrino V.
Price S.
Rosenzweig E.B.
Sakamoto T.
Salazar L.
Schmidt M.
Slutsky A.S.
Spaulding C.
Takayama H.
Takeda K.
Vuylsteke A.
Combes A.
Brodie D.
for The International ECMO Network (ECMONet) and The Extracorporeal Life Support Organization (ELSO)
Abstract
Extracorporeal membrane oxygenation (ECMO) has been used increasingly for both respiratory and cardiac failure in adult patients. Indications for ECMO use in cardiac failure include severe refractory cardiogenic shock, refractory ventricular arrhythmia, active cardiopulmonary resuscitation for cardiac arrest, and acute or decompensated right heart failure. Evidence is emerging to guide the use of this therapy for some of these indications, but there remains a need for additional evidence to guide best practices. As a result, the use of ECMO may vary widely across centers. The purpose of this document is to highlight key aspects of care delivery, with the goal of codifying the current use of this rapidly growing technology. A major challenge in this field is the need to emergently deploy ECMO for cardiac failure, often with limited time to assess the appropriateness of patients for the intervention. For this reason, we advocate for a multidisciplinary team of experts to guide institutional use of this therapy and the care of patients receiving it. Rigorous patient selection and careful attention to potential complications are key factors in optimizing patient outcomes. Seamless patient transport and clearly defined pathways for transition of care to centers capable of providing heart replacement therapies (e.g., durable ventricular assist device or heart transplantation) are essential to providing the highest level of care for those patients stabilized by ECMO but unable to be weaned from the device. Ultimately, concentration of the most complex care at high-volume centers with advanced cardiac capabilities may be a way to significantly improve the care of this patient population. ? 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM.
Subjects
Cardiac arrest; Cardiac failure; Critical care networks; Extracorporeal life support; Extracorporeal membrane oxygenation; Hospital organization; Mechanical circulatory support; Position article
SDGs
Other Subjects
adult; Article; artificial ventilation; extracorporeal oxygenation; health care delivery; heart center; heart failure; high volume hospital; human; nomenclature; patient safety; patient selection; patient transport; scientific literature; treatment contraindication; treatment indication; cardiogenic shock; heart assist device; heart transplantation; Adult; Extracorporeal Membrane Oxygenation; Heart Failure; Heart Transplantation; Heart-Assist Devices; Humans; Shock, Cardiogenic
Publisher
Springer Verlag
Type
journal article