Position paper for the organization of ECMO programs for cardiac failure in adults

• DOI: 10.1007/s00134-018-5064-5
• Publication Date: 2018-02-15T13:27:37Z
• Authors: Darryl Abrams; A. Reshad Garan; Akram Abdelbary; Matthew Bacchetta; Robert H. Bartlett; James Beck; Jan Belohlavek; Yih-Sharng Chen; Eddy Fan; Niall D. Ferguson; Jo-anne Fowles; John Fraser; Michelle Gong; Ibrahim F. Hassan; Carol Hodgson; Xiaotong Hou; Katarzyna Hryniewicz; Shingo Ichiba; William A. Jakobleff; Roberto Lorusso; Graeme MacLaren; Shay McGuinness; Thomas Mueller; Pauline K. Park; Giles Peek; Vin Pellegrino; Susanna Price; Erika B. Rosenzweig; Tetsuya Sakamoto; Leonardo Salazar; Matthieu Schmidt; Arthur S. Slutsky; Christian Spaulding; Hiroo Takayama; Koji Takeda; Alain Vuylsteke; Alain Combes; Daniel Brodie
• Keywords: Adult; Cardiac failure; ACUTE MYOCARDIAL-INFARCTION; PULMONARY ARTERIAL-HYPERTENSION; Hospital organization; RESPIRATORY-FAILURE; LIFE-SUPPORT; Shock, Cardiogenic; 610; Extracorporeal life support; Position article; EXTRACORPOREAL MEMBRANE-OXYGENATION; 03 medical and health sciences; Extracorporeal Membrane Oxygenation; 0302 clinical medicine; Mechanical circulatory support; AMERICAN-HEART-ASSOCIATION; Humans; REFRACTORY CARDIOGENIC-SHOCK; Critical care networks; Heart Failure; Extracorporeal membrane oxygenation; MECHANICAL CIRCULATORY SUPPORT; Cardiac arrest; 2009 INFLUENZA A(H1N1); 3. Good health; [SDV] Life Sciences [q-bio]; CARDIOPULMONARY-RESUSCITATION; Heart Transplantation; Heart-Assist Devices; 2706 Critical Care and Intensive Care Medicine

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.