This document replaces previous guidance on extracorporeal membrane oxygenation in adults (interventional procedure guidance 39).
1.1 Evidence on the safety of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory failure in adults is adequate but shows that there is a risk of serious side effects. Evidence on its efficacy is inadequate to draw firm conclusions: data from the recent CESAR (Conventional ventilation or extracorporeal membrane oxygenation for severe adult respiratory failure) trial were difficult to interpret because different management strategies were applied among many different hospitals in the control group and a single centre was used for the ECMO treatment group. Therefore this procedure should only be used with special arrangements for clinical governance, consent and research.
1.2 Clinicians wishing to undertake ECMO for severe acute respiratory failure in adults should take the following actions.
Inform the clinical governance leads in their Trusts.
Whenever possible, ensure that patients and their carers understand the uncertainty about the procedure's efficacy and its risks and provide them with clear written information. In addition, the use of NICE's information for patients ('Understanding NICE guidance') is recommended (available from www.nice.org.uk/IPG391/publicinfo).
1.3 Extracorporeal membrane oxygenation for severe acute respiratory failure in adults should only be carried out by clinical teams with specific training and expertise in the procedure.
1.4 Clinicians are encouraged to submit data on all adults undergoing ECMO for severe acute respiratory failure to the international Extracorporeal Life Support Organization register (www.elso.med.umich.edu).
1.5 NICE encourages further research into the use of innovative technologies for the management of severe acute respiratory failure, and may review this guidance on publication of further evidence.