1.1
Venoarterial extracorporeal membrane oxygenation (VA ECMO) can be used as an option for severe acute heart failure in adults as a bridge to recovery, a heart transplant or an implanted left ventricular assist device (LVAD).
1 Recommendations
As a bridge to recovery, heart transplant or implanted LVAD
When the potential for functional recovery is low or uncertain, and a heart transplant or implanted LVAD is unsuitable
1.2
More research is needed on VA ECMO for severe acute heart failure in adults when the potential for functional recovery is low or uncertain, and a heart transplant or an implanted LVAD is unsuitable, before it can be used in the NHS.
1.3
This procedure should only be done as part of formal research and an NHS research ethics committee needs to have approved its use.
What this means in practice
As a bridge to recovery, a heart transplant or an implanted LVAD
There is enough evidence on the safety and efficacy of this procedure for healthcare professionals to consider VA ECMO as an option as a bridge to recovery, a heart transplant or an implanted LVAD.
Healthcare professionals should discuss the available options with the person with severe acute heart failure (and their family members and carers as appropriate) before a joint decision is made, if possible (see NICE's page on shared decision making).
Hospital trusts will have their own policies on funding procedures and monitoring results. NHS England may also have policies on funding of procedures.
When the potential for functional recovery is low or uncertain, and a heart transplant or an implanted LVAD is unsuitable
There is not enough evidence to know if this procedure is efficacious when the potential for functional recovery is low or uncertain, and a heart transplant or an implanted LVAD is unsuitable. VA ECMO should only be done as part of formal research in this group.
For everyone having the procedure
Auditing of outcomes
Healthcare professionals doing this procedure should collect data on safety and outcomes of the procedure. Enter details about everyone having this procedure into the Extracorporeal Life Support Organization Registry and regularly review the data on outcomes and safety. Healthcare professionals are also encouraged to enter data into the cardiogenic shock module in the Intensive Care National Audit and Research Centre Case Mix Programme.
Who should be involved in the procedure
Patient selection should be done by a multidisciplinary team. The procedure could be done in centres specialising in managing severe acute heart failure and by healthcare professionals with specific training in this procedure.
What research is needed
More research is needed on:
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patient selection including:
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age
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comorbidities
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cause of severe acute heart failure
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predictors of recovery
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short- and long-term outcomes.
Why the committee made these recommendations
VA ECMO is not a treatment for severe acute heart failure. It is a short-term intervention that provides oxygenated blood to organs while a person's heart recovers, or before someone has a heart transplant or an implanted LVAD.
The prognosis for severe acute heart failure can depend on its causes, so recovery is more likely in some people, such as people with reversible causes. Evidence suggests that VA ECMO improves survival in these people while they recover, or before they have a heart transplant or an implanted LVAD.
For people with a low or uncertain chance of functional recovery who cannot have a heart transplant or an implanted LVAD, clinical trial evidence suggests that there is no benefit from VA ECMO. This may be because of the cause of their severe acute heart failure or because of their comorbidities. For this group, more research is needed on who might benefit from VA ECMO, so it should only be used in research.