Intensive Medicine sets the foundations to extend the use of ECMO to more types of patients


Extending the use of ECMO support to different pathologies related to the critical cardiac patient is possible, as pointed out by the intensivists who participated in the seminar ‘New frontiers in the management of patients with ECMO-VA’, organized last week by the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) with the collaboration of Getinge.

Integrating the ECMO team in patients with high-risk pulmonary embolism, in people who have suffered a cardiorespiratory arrest and even in the face of refractory septic shock is becoming a reality in Intensive Medicine, according to these experts from SEMICYUC.

The Extracorporeal Membrane Oxygenation system, better known as ECMO for its acronym in English, allows, among others, to perform respiratory function and clean the blood of patients with pulmonary insufficiency.

Its effectiveness has been demonstrated and it is a great alternative, but it requires a correct assessment of the patient, as well as the use by personnel expressly trained to handle these equipment. In addition, its use is not limited to the intra-hospital environment, but has saved many lives in recent years thanks to its use in out-of-hospital systems, both land and air.

The SEMICYUC has wanted to lay the foundations of the objectives and challenges that intensivists will face in the use of ECMO in the coming years. Taking this oxygenation therapy to other types of patients is possible and this is supported by different recent studies, which mark the way to integrate the technique in cases such as, for example, cardiorespiratory arrest, considered a first-order health problem.

“In those patients with refractory arrest, it is possible to consider the use of ECMO, which can improve survival to hospital discharge,” explained Dr. Jorge Duerto, from the San Carlos Clinical Hospital in Madrid.

For this, however, it is essential to have ECMO protocols in CPR that allow choosing and distinguishing the candidates who may benefit from the technique (by age, by arrest rhythm, by factors associated with survival, etc.). These protocols should also require a high level of intra-hospital and extra-hospital coordination and, of course, be accompanied by effective early detection and quality initial CPR.

Intensivists have also detailed how the use of ECMO can help in patients with high-risk Pulmonary Embolism (PE). Dr. María Paz Fuset, from the Bellvitge University Hospital in Barcelona, ​​has recalled the importance of having multidisciplinary protocols and rapid response teams since “a therapeutic strategy plan and consensual decision-making by specialists can influence the evolution of these patients “. Of course, it is important to choose the patient well, since it is not a technique that can be applied in a general way.

Regarding integrating the ECMO system in patients with refractory septic shock, intensivists have indicated that a higher survival rate has already been described if this therapy is used in the context of patients with myocarditis associated with sepsis, especially if it is started early .

“In addition, it enables cardiac recovery, since it is reversible,” said Dr. Ricardo Gimeno, from the Hospital Universitario La Fe in Valencia. The specialist has also warned of the risks: “We should not consider it in patients with refractory vasoplegia and we cannot ignore the possibility of bacteraemia during the use of ECMO”. For this reason, as in the previous cases, the adequate selection of patients is essential.

In addition, the seminar has addressed left ventricular decompression in the patient with ECMO. The management of the different existing techniques to achieve this decompression, as pointed out by Clara Hernández, from Harefield Hospital in London, is associated with lower mortality in patients with cardiogenic shock treated with ECMO support. “Current techniques allow immediate decompression and, in case of complications, also early decannulation”, he added.

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