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    VA ECMO for postcardiotomy cardiogenic shock in adults

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    1 Recommendation

    1.1

    Venoarterial extracorporeal membrane oxygenation (VA ECMO) can be used in the NHS during the evidence generation period as an option to manage postcardiotomy cardiogenic shock (PCS) in adults. There must be enhanced informed consent and auditing of outcomes.

    What this means in practice

    There are uncertainties around the safety and efficacy of VA ECMO to manage PCS. It could be used if needed while more evidence is generated.

    After this, this guidance will be reviewed and the recommendations may change.

    Healthcare professionals do not have to offer this procedure and should discuss the available options with the person with PCS (and their family and carers as appropriate) before a joint decision is made, if possible.

    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.

    Enhanced informed consent

    Because there are uncertainties about whether this procedure is safe and efficacious, there must be an emphasis on informed consent when possible. Healthcare professionals, when possible, must make sure that people (and their families and carers as appropriate) understand the uncertainty and lack of evidence around a procedure's safety and efficacy using NICE's advice on shared decision making and NICE's information for the public. Healthcare professionals must also inform the clinical governance leads in their organisation if they want to do 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.

    Who should be involved with the procedure

    Patient selection should be done by a suitably constituted multidisciplinary team. The procedure could be done in centres specialising in managing PCS and by healthcare professionals with specific training in this procedure.

    What evidence generation is needed

    Healthcare professionals must collect data specifically around the safety and efficacy of this procedure, including on:

    • patient selection

    • the technology used

    • short- and long-term survival outcomes

    • complication rates.

    Why the committee made this recommendation

    Some people with PCS do not survive being taken off a cardiopulmonary bypass machine after cardiac surgery. Evidence from observational studies suggests some of these people would survive if VA ECMO is used, and some people may benefit more than others. But there is a lack of good quality evidence.

    VA ECMO is only suitable for a small number of people and is only available in a few hospitals. So, it would be difficult to do randomised controlled trials in people with PCS. But other forms of data collection are possible. So, this procedure can be used in the NHS during the evidence generation period.