Position paper for the organization of ECMO programs for cardiac failure in adults

被引：231

作者：

Abrams, Darryl ^{[1
]}

Garan, A. Reshad ^{[2
]}

Abdelbary, Akram ^{[3
]}

Bacchetta, Matthew ^{[4
]}

Bartlett, Robert H. ^{[5
]}

Beck, James ^{[6
]}

Belohlavek, Jan ^{[7
,8
]}

Chen, Yih-Sharng ^{[9
]}

Fan, Eddy ^{[10
,11
]}

Ferguson, Niall D. ^{[10
,12
]}

Fowles, Jo-anne ^{[13
]}

Fraser, John ^{[14
,15
]}

Gong, Michelle ^{[16
]}

Hassan, Ibrahim F. ^{[17
]}

Hodgson, Carol ^{[18
,19
]}

Hou, Xiaotong ^{[20
]}

Hryniewicz, Katarzyna ^{[21
]}

Ichiba, Shingo ^{[22
]}

Jakobleff, William A. ^{[23
]}

Lorusso, Roberto ^{[24
]}

MacLaren, Graeme ^{[25
,26
]}

McGuinness, Shay ^{[27
,28
,29
]}

Mueller, Thomas ^{[30
]}

Park, Pauline K. ^{[5
]}

Peek, Giles ^{[23
]}

Pellegrino, Vin ^{[31
]}

Price, Susanna ^{[32
]}

Rosenzweig, Erika B. ^{[33
]}

Sakamoto, Tetsuya ^{[34
]}

Salazar, Leonardo ^{[35
]}

Schmidt, Matthieu ^{[36
,37
]}

Slutsky, Arthur S. ^{[38
,39
]}

Spaulding, Christian ^{[40
,41
]}

Takayama, Hiroo ^{[42
]}

Takeda, Koji ^{[42
]}

Vuylsteke, Alain ^{[13
]}

Combes, Alain ^{[36
,37
]}

Brodie, Daniel ^{[1
]}

机构：

[1] Columbia Univ, Coll Physicians & Surgeons, NewYork Presbyterian Hosp, Div Pulm Allergy & Crit Care, 622 W168th St,PH 8E,Room 101, New York, NY 10032 USA

[2] Columbia Univ, Med Ctr, Div Cardiol, New York, NY USA

[3] Cairo Univ, Crit Care Dept, Cairo, Egypt

[4] Columbia Univ, Dept Surg, Med Ctr, New York, NY USA

[5] Univ Michigan, Dept Surg, Ann Arbor, MI 48109 USA

[6] Columbia Univ, Med Ctr, Morgan Stanley Childrens Hosp New York, New York Presbyterian Hosp,Clin Perfus & Anesthes, New York, NY USA

[7] Charles Univ Prague, Fac Med 1, Dept Med 2, Prague, Czech Republic

[8] Gen Univ Hosp Prague, Prague, Czech Republic

[9] Natl Taiwan Univ Hosp, Dept Surg, Taipei, Taiwan

[10] Univ Toronto, Res Inst, Dept Physiol & Med, Interdept Div Crit Care Med,Inst Hlth Policy Mana, Toronto, ON, Canada

[11] Toronto Gen Hosp, Extracorporeal Life Support Program, Toronto, ON, Canada

[12] Toronto Gen Hosp, Univ Hlth Network & Sinai Hlth Syst, Div Respirol, Dept Med, Toronto, ON, Canada

[13] Papworth Hosp NHS Fdn Trust, Dept Anaesthesia & Intens Care, Cambridge, England

[14] Prince Charles Hosp, Adult Intens Care Serv, Brisbane, Qld, Australia

[15] Univ Queensland, Brisbane, Qld, Australia

[16] Montefiore Med Ctr, Jay B Langner Crit Care Serv, Dept Med, Div Crit Care Med, New York, NY USA

[17] Weill Cornell Med Coll Qatar, Hamad Med Corp, Doha, Qatar

[18] Monash Univ, Australian & New Zealand Intens Care Res Ctr, Melbourne, Vic, Australia

[19] Alfred Hosp, Physiotherapy Dept, Melbourne, Vic, Australia

[20] Capital Med Univ, Ctr Cardiac Intens Care, Anzhen Hosp, Beijing, Peoples R China

[21] Abbott North Western Hosp, Minneapolis Heart Inst, Minneapolis, MN USA

[22] Nippon Med Coll Hosp, Dept Surg Intens Care Med, Tokyo, Japan

[23] Albert Einstein Coll Med, Montefiore Med Ctr, Dept Cardiothorac Surg, New York, NY USA

[24] Maastricht Univ, Med Ctr, Cardiothorac Surg Dept, Heart & Vasc Ctr, Maastricht, Netherlands

[25] Natl Univ Hlth Syst, Cardiothorac ICU, Singapore, Singapore

[26] Royal Childrens Hosp, Paediat ICU, Melbourne, Vic, Australia

[27] Auckland City Hosp, Cardiothorac & Vasc ICU, Auckland, New Zealand

[28] Med Res Inst New Zealand, Wellington, New Zealand

[29] Monash Univ, Australia & New Zealand Intens Care Res Ctr, Melbourne, Vic, Australia

[30] Univ Hosp Regensburg, Dept Internal Med 2, Regensburg, Germany

[31] Alfred Hosp, Intens Care Unit, Melbourne, Vic, Australia

[32] Imperial Coll London, Natl Heart & Lung Inst, Royal Brompton & Harefield NHS Fdn Trust, London, England

[33] Columbia Univ, Div Pediat Cardiol, Med Ctr, New York, NY USA

[34] Teikyo Univ Hosp, Dept Emergency Med, Tokyo, Japan

[35] Fdn Cardiovasc Colombia, Dept Cardiol, Bucaramanga, Colombia

[36] Hop La Pitie Salpetriere, AP HP, Med Surg Intens Care Unit, F-75013 Paris, France

[37] Sorbonne Univ Paris, INSERM, Inst Cardiometab & Nutr, UMRS 1166,ICAN, Paris, France

[38] St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Res Ctr, Toronto, ON, Canada

[39] Univ Toronto, Interdept Div Crit Care Med, Dept Med, Toronto, ON, Canada

[40] Paris Descartes Univ, European Hosp Georges Pompidou, AP HP, Dept Cardiol, Paris, France

[41] Paris Descartes Univ, INSERM U 905, Sudden Death Expert Ctr, Paris, France

[42] Columbia Univ, Div Cardiac Vasc & Thorac Surg, Med Ctr, New York, NY USA

来源：

INTENSIVE CARE MEDICINE | 2018年 / 44卷 / 06期

关键词：

Extracorporeal membrane oxygenation; Extracorporeal life support; Mechanical circulatory support; Cardiac failure; Cardiac arrest; Hospital organization; Critical care networks; Position article; EXTRACORPOREAL MEMBRANE-OXYGENATION; MECHANICAL CIRCULATORY SUPPORT; REFRACTORY CARDIOGENIC-SHOCK; ACUTE MYOCARDIAL-INFARCTION; LIFE-SUPPORT; CARDIOPULMONARY-RESUSCITATION; ETHICAL DILEMMAS; HEART-FAILURE; PULMONARY; ARREST;

D O I：

10.1007/s00134-018-5064-5

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Extracorporeal membrane oxygenation (ECMO) has been used increasingly for both respiratory and cardiac failure in adult patients. Indications for ECMO use in cardiac failure include severe refractory cardiogenic shock, refractory ventricular arrhythmia, active cardiopulmonary resuscitation for cardiac arrest, and acute or decompensated right heart failure. Evidence is emerging to guide the use of this therapy for some of these indications, but there remains a need for additional evidence to guide best practices. As a result, the use of ECMO may vary widely across centers. The purpose of this document is to highlight key aspects of care delivery, with the goal of codifying the current use of this rapidly growing technology. A major challenge in this field is the need to emergently deploy ECMO for cardiac failure, often with limited time to assess the appropriateness of patients for the intervention. For this reason, we advocate for a multidisciplinary team of experts to guide institutional use of this therapy and the care of patients receiving it. Rigorous patient selection and careful attention to potential complications are key factors in optimizing patient outcomes. Seamless patient transport and clearly defined pathways for transition of care to centers capable of providing heart replacement therapies (e.g., durable ventricular assist device or heart transplantation) are essential to providing the highest level of care for those patients stabilized by ECMO but unable to be weaned from the device. Ultimately, concentration of the most complex care at high-volume centers with advanced cardiac capabilities may be a way to significantly improve the care of this patient population.

引用

页码：717 / 729

页数：13

共 69 条

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