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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.
More research is needed on VA ECMO for ECPR to manage in-hospital and out-of-hospital refractory cardiac arrest in adults without a shockable heart rhythm, 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.
More research is needed on:
patient selection
survival
neurological outcomes
timing of the intervention.
What this means in practice
For refractory cardiac arrest with a shockable heart rhythm
There is enough evidence on the safety and efficacy of this procedure for clinicians to consider VA ECMO as an option.
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.
For refractory cardiac arrest without a shockable heart rhythm
There is not enough evidence to know if this procedure is effective. VA ECMO for ECPR in adults without a shockable heart rhythm should only be done as part of formal research.
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 with specific training in this procedure, in centres that specialise in using VA ECMO for ECPR.
Clinical trial evidence suggests that using ECPR improves the likelihood of surviving with good brain function for people in refractory cardiac arrest with a shockable heart rhythm, compared with conventional CPR. So, it can be used for this group.
Clinical trial evidence is inconsistent for people in refractory cardiac arrest without a shockable heart rhythm. So, it is uncertain who in this group could benefit from this intervention and more research is needed.
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