American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Be in the know about ECMO

OCTOBER 23, 2017
Clinical Congress Daily Highlights, Monday First Edition

When it comes to extracorporeal membrane oxygenation (ECMO), successful treatment requires being informed and willing to adapt. ECMO, also known as ECLS (extracorporeal life support), can be administered in a wide range of cases where a patient’s heart and lungs are unable to provide adequate perfusion. ECMO works by providing mechanical circulatory support, passing blood from a person’s body through a device that oxygenates red blood cells.

The administration of ECMO is nuanced, expanding rapidly and varied in practice from institution to institution, as well as on patient-by-patient basis. During a Monday panel, speakers surveyed various applications of the device.

Paul Perry, MD, University of California, Davis, described nontraditional uses of ECMO during respiratory failure and trauma cases. While early data support ECMO as a means of improving survival in both areas, Dr. Perry noted that more trials and data are needed.

The use of ECMO in cardiogenic shock is exploding, said Ashok Babu, MD, St. Thomas Health, Nashville, TN, with better equipment, a rising incidence of shock and better outcomes driving the trend. ECMO provides interventional cardiologists with a new option to bridge cardiogenic shock patients as they move toward either implantation of a left ventricular assist device or a heart transplant.

ECMO also has an established history of pediatric use, including in the treatment of septic shock. Thomas Pranikoff, MD, FACS, Wake Forest School of Medicine, Winston-Salem, NC, provided background on the use of ECMO in this setting.

Several panelists pointed out the need to remember the challenges faced by patients undergoing ECMO, particularly those who have experienced acute respiratory distress syndrome (ARDS). Michael Hines, MD, FACS, Ochsner Health System, New Orleans, LA, stressed the need for patience and evaluating patients individually when considering interventions for the removal of excess fluid in ECMO patients, given the high risk for complications.

So what is the future of ECMO? According to M. Faraz Masood, MD, Washington University in St. Louis, MO, new protocols, techniques and instruments will further improve ECMO outcomes in patients.

Additional Information:
The Panel Session, Advanced Methods to Manage Acute Lung Injury and Hemodynamics, was held October 23 at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available online at FACS.org/clincon2017.

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