Extracorporeal membrane oxygenation (ECMO) and other forms of extracorporeal life support (ECLS) are increasingly employed to support patients with advanced cardiac and/or pulmonary failure as a bridge to recovery, long-term support, or transplantation. The premise underlying its application is that extracorporeal support can sustain gas exchange and circulatory function when conventional measures cannot, or when conventional measures increase risk of ventilator-induced lung injury or drug-induced myocardial injury. The overall topic issue is whether ECMO and related modalities improve outcome (survival or reduced long-term morbidity) or have other tangible benefits, such as economic benefits, that would support their continued use. Since different disease states are targeted, and different ECLS support modes are used, there are multiple yet related topic questions. Two topic questions should be addressed early since these represent the most rapid growth in ECLS:
- Should extracorporeal membrane oxygenation (ECMO) be used in severe pediatric and adult acute respiratory distress syndrome (ARDS) unresponsive to conventional mechanical ventilation? If so, when should it be applied and what techniques should be used?
- Should extracorporeal membrane oxygenation (ECMO) be used in witnessed pediatric and adult cardiac arrest unresponsive to conventional CPR? If so, what should be criteria for its use and what techniques should be used?
Describe your topic.
ECMO is an invasive therapy, requiring placement of peripheral vascular cannulas, extracorporeal circulation, and systemic anticoagulation, and is associated with known rates of complications. The potential benefit of ECMO in respiratory failure is reduction in mortality from hypoxemia and/or ventilator-induced lung injury with progressive organ failure. In cardiopulmonary arrest the potential benefit is to provide circulatory support until sustained return of spontaneous circulation and/or support for post-arrest cardiogenic shock pending interventional procedures. Thus, the topic is important due to the high underlying mortality rate and the risk of invasive therapy.
Describe why this topic is important.
The number of patients undergoing ECLS is growing exponentially as patients are increasingly referred to ECLS centers, and the number of hospitals offering ECLS is growing. Likewise, the number of published studies on ECLS is exponentially increasing. While guidelines have been developed by the Extracorporeal Life Support Organization (ELSO), they are based primarily on expert opinion. ELSO is interested in creating guidelines supported primarily by available evidence, and only secondarily by structured expert judgment. These guidelines would be used to support decisions on the use of ECLS globally.
Tell us why you are suggesting this topic.
2018-12-31
Target Date.
ELSO has spent several years developing an expanding number of guidelines specific to various aspects of ECLS. As mentioned above, these are based primarily on expert opinion, authored by one to three authors with input from a variable number of experienced individuals. The process is not formalized and is not heavily reliant on evidence-based medicine. Despite this, the guidelines have been widely accepted worldwide and referenced in numerous publications. ELSO is interested in developing evidence-based guidelines with the intent of publication in peer-reviewed journals.
Describe what you are doing currently and what you are hoping will change because of a new evidence report.
ELSO will use the evidence-based reports as the basis for the development of new upgraded guidelines. Where critical aspects of a topic cannot be supported by evidence, formal structured expert opinion techniques will be used to provide these aspects to supplement the evidence-based components. The result will be a guideline intended for peer-review publication. In order to increase acceptance of the guidelines, they will be developed in conjunction with stakeholder organizations, including ACCP, ATS, ACEP, STS, SCCM, and others. This multi-organizational effort is being organized as the International Collaborative on Extracorporeal Life Support (ICECLS, http://icecls.businesscatalyst.com).
How will you or your group use the information from a new evidence report?
ELSO plans two pathways for dissemination. First will be submission for peer-reviewed publication. The second is publication on the ELSO website (http://www.elso.org), where the current opinion-based guidelines are published, and to the ICECLS website above. The ELSO website has been widely successful for global distribution, and translation into other languages has begun.
How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
This topic is being proposed by ELSO, the Extracorporeal Life Support Organization, the only global organization focused on extracorporeal support. As indicated in Question 5, a number of stakeholder organizations will be included in guideline development as part of ICECLS.
Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
Information About You: (optional)
Provide a description of your role or perspective.
Physician, and Chairman of the Protocols Committee of ELSO, charged with guideline development
If you are you making a suggestion on behalf of an organization, please state the name of the organization.
Extracorporeal Life Support Organization (ELSO)
Please tell us how you heard about the Effective Health Care Program.
AHRQ website
