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    VA ECMO for severe acute heart failure in adults

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    2 Recommendations

    As a bridge to recovery, heart transplant or implanted LVAD

    2.1

    Venoarterial extracorporeal membrane oxygenation (VA ECMO) can be used as an option for severe acute heart failure as a bridge to recovery, a heart transplant or an implanted left ventricular assist device (LVAD).

    When recovery is unlikely and a heart transplant or implanted LVAD is not suitable

    2.2

    More research is needed on VA ECMO for severe acute heart failure when recovery is unlikely and a heart transplant or implanted LVAD is not suitable, before it can be used in the NHS.

    2.3

    This procedure should only be done as part of formal research and an NHS research ethics committee needs to have approved its use.

    What research is needed

    More research is needed on:

    • patient selection including age, comorbidities, and cause of severe acute heart failure

    • short- and long-term outcomes.

    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 clinicians to consider VA ECMO as an option for severe acute heart failure.

    Clinicians do not have to offer this procedure and should always discuss the available options before making a decision. You can find out more on our webpage on making decisions about your care.

    Hospital trusts will have their own policies on funding procedures and getting permission to do operations and monitoring results. NHS England may also have policies on funding of procedures.

    When recovery is unlikely and a heart transplant or an implanted LVAD is not suitable

    There is not enough evidence to know if this procedure is effective when recovery is unlikely and a heart transplant or an implanted LVAD is not suitable. VA ECMO should only be done as part of formal research in this group.

    For everyone having the procedure

    Auditing of outcomes

    Clinicians 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.

    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 managing severe acute heart failure with specific training in this procedure.

    Why the committee made these recommendations

    VA ECMO is not a treatment for severe acute heart failure. It is a short-term intervention to stabilise a person's condition while they recover or before they have 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. Evidence suggests that VA ECMO improves survival in these people while they recover or before having a heart transplant or an implanted LVAD.

    For people with a low chance of 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 and so VA ECMO should only be used in research.