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Intensive Care Med. 2018 Jun;44(6):717-729. doi: 10.1007/s00134-018-5064-5. Epub 2018 Feb 15.

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

Author information

1
Division of Pulmonary, Allergy, and Critical Care, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, 622 W168th St, PH 8E, Room 101, New York, NY, 10032, USA.
2
Division of Cardiology, Columbia University Medical Center, New York, NY, USA.
3
Critical Care Department, Cairo University, Cairo, Egypt.
4
Department of Surgery, Columbia University Medical Center, New York, NY, USA.
5
Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
6
Clinical Perfusion & Anesthesia Support Services, New York Presbyterian Hospital, Columbia University Medical Center, Morgan Stanley Children's Hospital of New York, New York, NY, USA.
7
Second Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
8
Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
9
Interdepartmental Division of Critical Care Medicine, Departments of Medicine and Physiology, Institute for Health Policy, Management, and Evaluation, University of Toronto Research Institute, Toronto, Canada.
10
Extracorporeal Life Support Program, Toronto General Hospital, Toronto, Canada.
11
Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, Toronto General Hospital, Toronto, Canada.
12
Department of Anaesthesia and Intensive Care, Papworth Hospital NHS Foundation Trust, Cambridge, UK.
13
Adult Intensive Care Service, The Prince Charles Hospital and University of Queensland, Brisbane, Australia.
14
Division of Critical Care Medicine, Department of Medicine, Jay B. Langner Critical Care Service, Montefiore Medical Center, New York, NY, USA.
15
Hamad Medical Corporation, Weill Cornell Medical College in Qatar, Doha, Qatar.
16
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
17
Physiotherapy Department, The Alfred Hospital, Melbourne, Australia.
18
Center for Cardiac Intensive Care, Capital Medical University Affiliated Anzhen Hospital, Beijing, People's Republic of China.
19
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
20
Department of Surgical Intensive Care Medicine, Nippon Medical School Hospital, Tokyo, Japan.
21
Department of Cardiothoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA.
22
Cardiothoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.
23
Cardiothoracic ICU, National University Health System, Singapore, Singapore.
24
Paediatric ICU, Royal Children's Hospital, Melbourne, Australia.
25
Cardiothoracic and Vascular ICU, Auckland City Hospital, Auckland, New Zealand.
26
Medical Research Institute of New Zealand, Wellington, New Zealand.
27
Australia and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
28
Department of Internal Medicine II, University Hospital of Regensburg, Regensburg, Germany.
29
Intensive Care Unit, The Alfred Hospital, Melbourne, Australia.
30
Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK.
31
Division of Pediatric Cardiology, Columbia University Medical Center, New York, NY, USA.
32
Department of Emergency Medicine, Teikyo University Hospital, Tokyo, Japan.
33
Department of Cardiology, Fundación Cardiovascular de Colombia, Bucaramanga, Colombia.
34
Medical-Surgical Intensive Care Unit, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 75013, Paris, France.
35
INSERM, Institute of Cardiometabolism and Nutrition UMRS_1166-ICAN, Sorbonne University Paris, Paris, France.
36
Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
37
Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, Canada.
38
Department of Cardiology, European Hospital Georges Pompidou, Assistance Publique Hôpitaux de Paris and Sudden Death Expert Center, INSERM U 905, Paris Descartes University, Paris, France.
39
Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, NY, USA.
40
Division of Pulmonary, Allergy, and Critical Care, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, 622 W168th St, PH 8E, Room 101, New York, NY, 10032, USA. hdb5@cumc.columbia.edu.

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.

KEYWORDS:

Cardiac arrest; Cardiac failure; Critical care networks; Extracorporeal life support; Extracorporeal membrane oxygenation; Hospital organization; Mechanical circulatory support; Position article

PMID:
29450594
DOI:
10.1007/s00134-018-5064-5

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