The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Extracorporeal membrane oxygenation (ECMO) for acute heart failure in adults, in March 2014.
Heart failure is a complex clinical syndrome of symptoms and signs that occurs when the efficiency of the heart as a pump is impaired. It can lead to reduced blood flow to the body tissues and increased filling pressure in the heart, which causes congestion and oedema in the lungs (causing breathlessness) and/or the body (causing swelling of the legs). Other symptoms include reduced exercise tolerance, fatigue and malaise.
The most common cause of heart failure in the UK is coronary artery disease. Around 900,000 people in the UK have heart failure. It has a poor prognosis: 30–40% of patients diagnosed with heart failure die within a year – but thereafter the mortality is less than 10% per year. There is evidence of a trend towards improved prognosis, with the 6‑month mortality rate decreasing from 26% in 1995 to 14% in 2005.
Treatment for acute heart failure (specifically, sudden significant deterioration in people with known cardiac dysfunction or new onset of symptoms in people without previous cardiac dysfunction) involves pharmacological therapies, including diuretics and inotropic agents. Invasive therapies include electrophysiological intervention such as pacemakers or implantable cardioverter-defibrillators, revascularisation procedures such as percutaneous coronary intervention, valve replacement or repair, and temporary use of intra-aortic balloon pumps or ventricular assist devices.
X58.1 Extracorporeal membrane oxygenation
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, and specifically any special arrangements relating to the introduction of new interventional procedures. 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.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
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. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
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.