Venoarterial extracorporeal membrane oxygenation (VA ECMO) for extracorporeal cardiopulmonary resuscitation (ECPR) can be used as an option to manage in-hospital and out-of-hospital refractory cardiac arrest in adults with a shockable heart rhythm or reversible causes.
More research is needed on VA ECMO for ECPR to manage in-hospital and out-of-hospital refractory cardiac arrest in adults with a non-shockable heart rhythm or irreversible causes, before it can be used in the NHS.
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
For refractory cardiac arrest with a shockable heart rhythm or reversible causes
There is enough evidence on the safety and efficacy of this procedure for healthcare professionals to consider VA ECMO for ECPR as an option.
Healthcare professionals should discuss the available options with the person with refractory cardiac arrest (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.
For refractory cardiac arrest with a non-shockable heart rhythm or irreversible causes
There is not enough evidence to know if this procedure is effective. VA ECMO for ECPR should only be done as part of formal research.
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 National Cardiac Arrest Audit.
Who should be involved in the procedure
Patient selection should be done by a multidisciplinary team. The procedure should only be done in centres specialising in using VA ECMO for ECPR for refractory cardiac arrest and by healthcare professionals with specific training in this procedure.
More research is needed on:
patient selection
survival
neurological outcomes
timing of the intervention.
Clinical trial evidence suggests that, compared with conventional CPR, using VA ECMO for ECPR improves the likelihood of surviving with good brain function in adults with refractory cardiac arrest with a shockable heart rhythm or reversible causes. So, it can be used for this group.
Clinical trial evidence is inconsistent for VA ECMO for ECPR in adults with refractory cardiac arrest with a non-shockable heart rhythm or irreversible causes. So, it is uncertain who in this group could benefit from this intervention, and more research is needed.