The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on extracorporeal membrane oxygenation in postneonatal children.
Extracorporeal membrane oxygenation (ECMO) (also known as extracorporeal life support) is indicated for respiratory or cardiac failure unresponsive to all other measures, but considered to have a reversible cause. Most children treated with ECMO are very seriously ill and its use is rare. ECMO may also be used following heart surgery to ease the transition from cardiopulmonary bypass.
ECMO is a temporary life support technique. It involves connecting the child's internal circulation to an external blood pump and artificial lung. A catheter placed in the right side of the heart carries blood to a pump, then to a membrane oxygenator, where gas exchange of oxygen and carbon dioxide takes place. The blood then passes through tubing back into either the venous or arterial circulation. Patients are given an anticoagulant, to prevent blood clotting in the external system. Bleeding is therefore an adverse effect. Others include blood infection and haemolysis (breaking up of blood cells).
Conventional treatment is maximal intensive care support without ECMO. Ventricular assist devices, which pump the blood externally but do not allow gas transfer, may be used in addition to standard ventilation, where circulatory rather than respiratory failure is prominent.
ECMO has been shown to improve survival compared with conventional management in babies under the age of 28 days with severe respiratory failure.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.