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

Abrams, Darryl; Garan, A.R.; Abdelbary, Akram; Bacchetta, Matthew; Bartlett, Robert H.; Beck, Jürgen; Bělohlávek, Jan; Chen, Yih‐Sharng; Fan, Eddy; Ferguson, Niall D.; Fowles, Jo Anne; Fraser, John F.; Gong, Michelle N.; Hassan, Ibrahim Fawzy; Hodgson, Carol; Hou, Xiaotong; Hryniewicz, Katarzyna; Ichiba, Shingo; Jakobleff, William; Lorusso, Roberto; MacLaren, Graeme; McGuinness, Shay; Mueller, Thomas; Park, Pauline K.; Peek, Giles J.; Pellegrino, Vin; Price, Susanna; Rosenzweig, Erika B.; Sakamoto, Tetsuya; Salazar, Leonardo; Schmidt, Matthieu; Slutsky, Arthur S.; Spaulding, Christian; Takayama, Hiroo; Takeda, Koji; Vuylsteke, Alain; Combes, Alain; Brodie, Daniel

doi:10.1007/s00134-018-5064-5

Cited by 249 publications

(209 citation statements)

References 69 publications

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“…Prior studies suggest that these ECMO survivors are at higher risks for neurological injuries and cognitive impairments. 5,6,29,30 Our study is limited by retrospective data retrieval prone to lack of precision and bias. Without recent neuroimaging and neuropsychological testing, it remains uncertain if some of the survivors in our study had neurocognitive impairments that affected their functioning or HRQL.…”

Section: Discussionmentioning

confidence: 99%

Health‐related quality of life after extracorporeal membrane oxygenation: a single centre's experience

et al. 2019

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Aims The aims of this study were to evaluate health‐related quality of life (HRQL) among patients treated with extracorporeal membrane oxygenation (ECMO) in northern Norway over a period of 27 years (1988–2015) and to identify variables related to HRQL. Methods and results A retrospective inquiry of the ECMO registry at the University Hospital of North Norway identified 74 ECMO‐treated patients (mean age 49 years, 65% males). Acute cardiac failure was the dominant indication (58%), and venoarterial ECMO was the dominant mode of treatment (87%). Mortality for discharged patients was recorded on 20 September 2016. Thirty (41%) survivors were identified. Twenty‐three survivors were eligible for the survey and received a set of questionnaires at home. The main outcome measure was HRQL as measured with the 36‐item Short‐Form health survey (SF‐36) (RAND Short Form‐36 v1.2). Other questionnaires covered demographic information, problems with functioning in usual daily activities (such as hobbies, household chores, family, or work), employment status, and psychological distress. The survey was completed by 20 (87%) survivors (mean age = 49 years, 12 men). Indications for ECMO treatment (VA = 90%) had been respiratory failure (25%), cardiac failure (60%), and extracorporeal cardiopulmonary resuscitation (15%). The average time since ECMO treatment was 6.5 years. Seventy‐five percent reported mental HRQL (SF‐36 Mental Component Summary, mean = 43, SD = 5) or physical HRQL (SF‐36 Physical Component Summary, mean = 43, SD = 4.5) within the normal range (T = 50 ± 10) in comparison with age‐matched population data from national norms. Half of the responders reported problems on the SF‐36 subscales general health and role physical. Seventy percent reported problems on the SF‐36 subscale role emotional. All but one responder lived independently without any organized care, and 90% reported no problems related to basic self‐care. Half of those in working age had returned to work after ECMO treatment. Forty percent of the responders reported some degree of restrictions in usual daily activities, problems with mobility (35%), anxiety/depression (35%), or pain/discomfort (55%). Significant univariate associations were observed for poorer HRQL and higher reports of psychological distress, pain, and experiencing restrictions in usual everyday activities. Improved HRQL was significantly related to an extended time since ECMO treatment. Conclusions Our survey indicates an overall positive long‐term HRQL outcome for our ECMO survivors. A subset reported problems with functioning and HRQL. Future research should focus on identification of the survivors at risk for poor recovery who may benefit from rehabilitation interventions.

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Section: Discussionmentioning

confidence: 99%

Health‐related quality of life after extracorporeal membrane oxygenation: a single centre's experience

et al. 2019

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“…A strategy that combines ECLS with an awake, endotracheally extubated approach is one most likely to avoid complications associated with sedation and invasive mechanical ventilation while facilitating physical therapy to help maintain transplant candidacy . To further maximize the chances of successful physical conditioning, including ambulation, an upper‐body ECLS configuration is often preferred …”

Section: Indications For Eclsmentioning

confidence: 99%

“…An absolute contraindication to ECLS is severe, irreversible respiratory or cardiac failure without eligibility for transplantation or VAD . Cardiac‐specific absolute contraindications to venoarterial ECLS include severe aortic insufficiency and acute aortic dissection.…”

Section: Contraindications To Eclsmentioning

confidence: 99%

“…12 To further maximize the chances of successful physical conditioning, including ambulation, an upper-body ECLS configuration is often preferred. 12,13 Bridge to Recovery, Ventricular Assist Device, or Heart Transplantation in Patients with Cardiac Failure Several etiologies of cardiac failure are manageable with venoarterial ECLS, including severe refractory cardiogenic shock, extracorporeal cardiopulmonary resuscitation (ECPR) during cardiac arrest, and refractory ventricular arrhythmias ( Table 1). 4 Evidence supporting the use of ECLS for each of these indications is limited, 13 with ECPR often considered as a distinct therapeutic option because the patient population and outcomes differ significantly from those for other indications.…”

Section: Bridge To Lung Transplantation In Patients With End-stage Lumentioning

confidence: 99%

“…12,13 Bridge to Recovery, Ventricular Assist Device, or Heart Transplantation in Patients with Cardiac Failure Several etiologies of cardiac failure are manageable with venoarterial ECLS, including severe refractory cardiogenic shock, extracorporeal cardiopulmonary resuscitation (ECPR) during cardiac arrest, and refractory ventricular arrhythmias ( Table 1). 4 Evidence supporting the use of ECLS for each of these indications is limited, 13 with ECPR often considered as a distinct therapeutic option because the patient population and outcomes differ significantly from those for other indications. Unlike in respiratory failure, the existence of a destination device therapy, in the form of a ventricular assist device (VAD), broadens the potential indication for venoarterial ECLS in patients with cardiogenic shock.…”

Section: Bridge To Lung Transplantation In Patients With End-stage Lumentioning

confidence: 99%

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Ventilatory and Pharmacotherapeutic Strategies for Management of Adult Patients on Extracorporeal Life Support

et al. 2019

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Extracorporeal life support (ECLS) can provide mechanical support for patients with severe life‐threatening cardiac or respiratory failure. ECLS is a complex therapy that has increased in use over several decades owing to advances in technology. In concert with this growth, there is an increased need to understand the complexity of this technology to augment the effectiveness of ECLS and minimize complications such as ventilator‐induced lung injury, bleeding, thrombosis, infections, and inadequate drug dosing. The purpose of this review was to discuss management strategies in adult patients receiving ECLS and provide recommendations on ventilator management, provision of adequate analgesia and sedation, treatment and prevention of infections, and anticoagulation.

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Extracorporeal Life Support for Adults With Respiratory Failure and Related Indications

Brodie

Slutsky

Combes

2019

JAMA

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280

269

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t is estimated that nearly 2 million people with acute respiratory failure are hospitalized annually in the United States at a cost exceeding $50 billion. 1 Approximately half require invasive mechanical ventilation, and in-hospital mortality exceeds 20% in these patients. 1 Mechanical ventilation has been the primary management tool for patients with acute respiratory failure since the 1950s' polio epidemic, yet it is associated with major complications that can increase mortality. 2 Consequently, there is a need for better ventilatory strategies, as well as alternative modes of respiratory support. In this setting, extracorporeal life support (ECLS), which provides gas exchange via an extracorporeal circuit, is increasingly being used to provide support to failing lungs, a failing heart, or both (Figure 1).Rudimentary versions of ECLS developed in the 1970s were used for several decades but were largely abandoned because they lacked compelling evidence for their efficacy and resulted in major complications. 3,4 However, improvements in technology renewed interest in ECLS. 5 Over the last decade, use of ECLS has substantially increased (eFigure, A in the Supplement), at times, far outpacing the evidence justifying its use. [5][6][7] An increasing evidence base now supports greater use of ECLS for adult patients in respiratory failure. [8][9][10][11] This review examines the reemergence of ECLS, discussing the physiologic rationale, current evidence, indications, and complications associated with its use in adult patients with respiratory failure and other related conditions. Importantly, ethical IMPORTANCE The substantial growth over the last decade in the use of extracorporeal life support for adults with acute respiratory failure reveals an enthusiasm for the technology not always consistent with the evidence. However, recent high-quality data, primarily in patients with acute respiratory distress syndrome, have made extracorporeal life support more widely accepted in clinical practice.OBSERVATIONS Clinical trials of extracorporeal life support for acute respiratory failure in adults in the 1970s and 1990s failed to demonstrate benefit, reducing use of the intervention for decades and relegating it to a small number of centers. Nonetheless, technological improvements in extracorporeal support made it safer to use. Interest in extracorporeal life support increased with the confluence of 2 events in 2009:(1) the publication of a randomized clinical trial of extracorporeal life support for acute respiratory failure and (2) the use of extracorporeal life support in patients with severe acute respiratory distress syndrome during the influenza A(H1N1) pandemic. In 2018, a randomized clinical trial in patients with very severe acute respiratory distress syndrome demonstrated a seemingly large decrease in mortality from 46% to 35%, but this difference was not statistically significant. However, a Bayesian post hoc analysis of this trial and a subsequent meta-analysis together suggested that extracorporeal life suppo...

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

Cited by 249 publications

References 69 publications

Health‐related quality of life after extracorporeal membrane oxygenation: a single centre's experience

Health‐related quality of life after extracorporeal membrane oxygenation: a single centre's experience

Ventilatory and Pharmacotherapeutic Strategies for Management of Adult Patients on Extracorporeal Life Support

Extracorporeal Life Support for Adults With Respiratory Failure and Related Indications

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