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    VA ECMO for postcardiotomy cardiogenic shock in adults

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    2 Recommendations

    2.1

    More research is needed on venoarterial extracorporeal membrane oxygenation (VA ECMO) to manage postcardiotomy cardiogenic shock (PCS) before it can be used in the NHS.

    2.2

    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

    • short- and long-term survival outcomes.

    What this means in practice

    There is not enough evidence to know if this procedure is effective. VA ECMO to manage PCS should only be done as part of formal research.

    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 with the procedure

    Patient selection should be done by a multidisciplinary team with specific training in this procedure, in centres that specialise in managing postcardiotomy cardiogenic shock.

    Why the committee made these recommendations

    Evidence from observational studies suggests that some people with PCS, who would not survive being taken off a cardiopulmonary bypass machine after cardiac surgery, may survive if VA ECMO is used, but it is limited.

    There is some evidence that some people may benefit more from VA ECMO than others. More research is needed on survival outcomes with VA ECMO, so it should only be used in research.