Information for the public
There is good evidence about how well ECMO works but it isn't clear who would most benefit from it. There is also a high risk of serious complications. So this procedure should only be used if extra care is taken to explain the risks, and extra steps are put in place to record and review what happens.
NICE is asking health professionals to send information about everyone who has ECMO and what happens to them afterwards to a database at the international Extracorporeal Life Support Organization, so that the safety of the procedure and how well it works can be checked over time.
More research on this procedure is needed.
Your health professional should fully explain what is involved in having this procedure and discuss the possible benefits and risks with you. In particular, they should explain the uncertainty about the evidence on how likely it is to improve your symptoms and on possible side effects. You should also be told how to find more information about ECMO. You should only be asked if you want to agree to this procedure after having this discussion.
Your health professional should ask you if details of your procedure can be collected.
NICE said that it was difficult to decide who would most benefit from this procedure because the evidence was from patients with different conditions. It also said that ECMO was only suitable for short-term support so, before starting ECMO, health professionals would need to have a plan in place for how to support the patient afterwards.
NICE was told that the procedure should only be used for patients whose condition would not get better with other treatments, and whose acute heart failure is likely to recover, or if there was a clear plan for what would happen afterwards – for example, a heart transplant. NICE was also told that ECMO may need to be withdrawn from patients whose heart failure is not likely to recover or who cannot have more treatment.
In an emergency, healthcare professionals may give treatment immediately, without obtaining your informed consent, when it is in your best interests.