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

  • 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
  • for The International ECMO Network (ECMONet) and The Extracorporeal Life Support Organization (ELSO)
Conference Reports and Expert Panel

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

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

Notes

Funding

CH is supported by a Future Leader Fellowship from the National Heart Foundation of Australia (Award ID: 101168); funding source had no role in the writing of the manuscript or the decision to submit for publication. PKP receives funding support from the National Heart, Lung, and Blood Institute (NHLBI), National Institute of Allergy and Infectious Diseases (NIAID), Food and Drug Administration/Biomedical Advanced Research and Development Authority (FDA/BARDA), Bristol-Myers Squibb, and AtoxBio; funding sources had no role in the writing of the manuscript or the decision to submit for publication.

Compliance with ethical standards

Conflicts of interest

DB is currently on the medical advisory boards of ALung Technologies and Kadence. All compensation for these activities is paid to Columbia University. All other authors have no conflicts of interest to report.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Darryl Abrams
    • 1
  • A. Reshad Garan
    • 2
  • Akram Abdelbary
    • 3
  • Matthew Bacchetta
    • 4
  • Robert H. Bartlett
    • 5
  • James Beck
    • 6
  • Jan Belohlavek
    • 7
  • Yih-Sharng Chen
    • 8
  • Eddy Fan
    • 9
    • 10
  • Niall D. Ferguson
    • 9
    • 11
  • Jo-anne Fowles
    • 12
  • John Fraser
    • 13
  • Michelle Gong
    • 14
  • Ibrahim F. Hassan
    • 15
  • Carol Hodgson
    • 16
    • 17
  • Xiaotong Hou
    • 18
  • Katarzyna Hryniewicz
    • 19
  • Shingo Ichiba
    • 20
  • William A. Jakobleff
    • 21
  • Roberto Lorusso
    • 22
  • Graeme MacLaren
    • 23
    • 24
  • Shay McGuinness
    • 25
    • 26
    • 27
  • Thomas Mueller
    • 28
  • Pauline K. Park
    • 5
  • Giles Peek
    • 21
  • Vin Pellegrino
    • 29
  • Susanna Price
    • 30
  • Erika B. Rosenzweig
    • 31
  • Tetsuya Sakamoto
    • 32
  • Leonardo Salazar
    • 33
  • Matthieu Schmidt
    • 34
    • 35
  • Arthur S. Slutsky
    • 36
    • 37
  • Christian Spaulding
    • 38
  • Hiroo Takayama
    • 39
  • Koji Takeda
    • 39
  • Alain Vuylsteke
    • 12
  • Alain Combes
    • 34
    • 35
  • Daniel Brodie
    • 1
  • for The International ECMO Network (ECMONet) and The Extracorporeal Life Support Organization (ELSO)
  1. 1.Division of Pulmonary, Allergy, and Critical CareColumbia University College of Physicians and Surgeons/NewYork-Presbyterian HospitalNew YorkUSA
  2. 2.Division of CardiologyColumbia University Medical CenterNew YorkUSA
  3. 3.Critical Care DepartmentCairo UniversityCairoEgypt
  4. 4.Department of SurgeryColumbia University Medical CenterNew YorkUSA
  5. 5.Department of SurgeryUniversity of MichiganAnn ArborUSA
  6. 6.Clinical Perfusion & Anesthesia Support Services, New York Presbyterian Hospital, Columbia University Medical CenterMorgan Stanley Children’s Hospital of New YorkNew YorkUSA
  7. 7.Second Department of Medicine, First Faculty of MedicineCharles University and General University Hospital in PraguePragueCzech Republic
  8. 8.Department of SurgeryNational Taiwan University HospitalTaipeiTaiwan
  9. 9.Interdepartmental Division of Critical Care Medicine, Departments of Medicine and Physiology, Institute for Health Policy, Management, and EvaluationUniversity of Toronto Research InstituteTorontoCanada
  10. 10.Extracorporeal Life Support ProgramToronto General HospitalTorontoCanada
  11. 11.Division of Respirology, Department of Medicine, University Health Network and Sinai Health SystemToronto General HospitalTorontoCanada
  12. 12.Department of Anaesthesia and Intensive CarePapworth Hospital NHS Foundation TrustCambridgeUK
  13. 13.Adult Intensive Care ServiceThe Prince Charles Hospital and University of QueenslandBrisbaneAustralia
  14. 14.Division of Critical Care Medicine, Department of Medicine, Jay B. Langner Critical Care ServiceMontefiore Medical CenterNew YorkUSA
  15. 15.Hamad Medical CorporationWeill Cornell Medical College in QatarDohaQatar
  16. 16.Australian and New Zealand Intensive Care Research CentreMonash UniversityMelbourneAustralia
  17. 17.Physiotherapy DepartmentThe Alfred HospitalMelbourneAustralia
  18. 18.Center for Cardiac Intensive CareCapital Medical University Affiliated Anzhen HospitalBeijingPeople’s Republic of China
  19. 19.Minneapolis Heart InstituteAbbott Northwestern HospitalMinneapolisUSA
  20. 20.Department of Surgical Intensive Care MedicineNippon Medical School HospitalTokyoJapan
  21. 21.Department of Cardiothoracic Surgery, Montefiore Medical CenterAlbert Einstein College of MedicineNew YorkUSA
  22. 22.Cardiothoracic Surgery Department, Heart and Vascular CentreMaastricht University Medical CentreMaastrichtThe Netherlands
  23. 23.Cardiothoracic ICUNational University Health SystemSingaporeSingapore
  24. 24.Paediatric ICURoyal Children’s HospitalMelbourneAustralia
  25. 25.Cardiothoracic and Vascular ICUAuckland City HospitalAucklandNew Zealand
  26. 26.Medical Research Institute of New ZealandWellingtonNew Zealand
  27. 27.Australia and New Zealand Intensive Care Research CentreMonash UniversityMelbourneAustralia
  28. 28.Department of Internal Medicine IIUniversity Hospital of RegensburgRegensburgGermany
  29. 29.Intensive Care UnitThe Alfred HospitalMelbourneAustralia
  30. 30.Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung InstituteImperial College LondonLondonUK
  31. 31.Division of Pediatric CardiologyColumbia University Medical CenterNew YorkUSA
  32. 32.Department of Emergency MedicineTeikyo University HospitalTokyoJapan
  33. 33.Department of CardiologyFundación Cardiovascular de ColombiaBucaramangaColombia
  34. 34.Medical-Surgical Intensive Care Unit, Hôpital Pitié-SalpêtrièreAssistance Publique-Hôpitaux de ParisParisFrance
  35. 35.INSERM, Institute of Cardiometabolism and Nutrition UMRS_1166-ICANSorbonne University ParisParisFrance
  36. 36.Keenan Research Center, Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  37. 37.Interdepartmental Division of Critical Care Medicine, Department of MedicineUniversity of TorontoTorontoCanada
  38. 38.Department of Cardiology, European Hospital Georges Pompidou, Assistance Publique Hôpitaux de Paris and Sudden Death Expert Center, INSERM U 905Paris Descartes UniversityParisFrance
  39. 39.Division of Cardiac, Vascular and Thoracic SurgeryColumbia University Medical CenterNew YorkUSA

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