Intraoperative Management of Adult Patients on Extracorporeal Membrane Oxygenation: An Expert Consensus Statement From the Society of Cardiovascular Anesthesiologists—Part I, Technical Aspects of Extracorporeal Membrane Oxygenation

Abstract

Extracorporeal membrane oxygenation (ECMO) is used to support patients with refractory cardiopulmonary failure. Given ECMO’s increased use in adults and the fact that many ECMO patients are cared for by anesthesiologists, the Society of Cardiovascular Anesthesiologists ECMO working group created an expert consensus statement that is intended to help anesthesiologists manage adult ECMO patients who are cared for in the operating room. In the first part of this 2-part series, technical aspects of ECMO are discussed, and related expert consensus statements are provided.

Transesophageal Echocardiography in Critical Care

“…Indications include refractory cardiogenic shock, high-risk PCI/cardiac procedures, refractory arrhythmias and as a bridge to transplant or LVAD [13,31,34]. Central cannulation involves venous cannula placement in the RA or SVC and IVC, visible in the bicaval view [35] as seen in Fig. 9.…”

“…VV ECMO is used for patients whose oxygenation and ventilation are compromised despite appropriate mechanical ventilation and medical therapy. Extracorporeal Life Support Organization (ELSO) guidelines help provide direction on indications, maintenance and weaning of VV ECMO [34,35] Venous blood can be drained from the SVC, IVC, RA or femoral vein. In single-site and two-site insertions, oxygenated blood is returned to the RA with its direction towards the tricuspid valve.…”

“…In single-site and two-site insertions, oxygenated blood is returned to the RA with its direction towards the tricuspid valve. This can be visualized on the TEE in the ME four-chamber view, RV inflow-outflow view, and modified bicaval view [13,31,35].…”

Society of Cardiovascular Anesthesiologists Consensus Statement on Intraoperative Management of Extracorporeal Membrane Oxygenation: A New Instrument in the Perioperative Medicine Toolkit

“…The Society of Cardiovascular Anesthesiologists is unwavering in its commitment to provide advice, assistance, and recommendations for all health care providers who enjoy the privilege of taking care of patients on ECMO. We believe the contributions from Mazzeffi et al 8,9 will help anesthesiologists and allied health caregivers to take better care of their patients.…”

“…6 The Extracorporeal Life Support Organization (ELSO) has published guidelines for the management of ECMO patients in an intensive care setting. 7 In this edition of the Journal, Mazzeffi et al 8,9 present a 2-part consensus statement sponsored by the Society of Cardiovascular Anesthesiologists on the intraoperative management of ECMO patients. These documents aim to guide physicians in clinical decision making and to assist in standardizing care and decrease variability across different centers as ECMO practices vary significantly among different institutions.…”