Objective

Some deaths may be prevented by the use of VA-ECMO in heart failure following cardiac surgery. Our centre has limited ECMO experience but it has been increasingly used. ECMO use in a non-ECMO unit raises issues regarding its implementation, maintenance, service impact and governance. We review our experience with post cardiotomy ECMO, survey ECMO use and raise issues on the use of ECMO in non-ECMO units and whether it should be standard of care in resistant post cardiotomy heart failure.

Methods

A retrospective review of patients who were placed on VA-ECMO in our centre was undertaken. A survey was conducted of non-ECMO cardiac surgical units to assess how many performed post-cardiotomy ECMO, how they managed these patients and their outcomes.

Results

VA-ECMO post cardiac surgery was used in 5 patients in situations such as inability to wean off bypass and post-surgery cardiac arrest. 60% male, median age 42 yrs (28-63 yrs), and a total of 23 days ECMO management (average 4.6 days per patient). One patient survived to discharge and one transferred to a transplant centre on ECMO. We found that >2/3 of units have performed ECMO with variable results. Not all units owned ECMO equipment or could care for patients once established on ECMO.

Conclusion

Our survival is consistent with overseas figures. ECMO use in the UK is not restricted to ECMO units. Issues identified include: should cardiac units have ECMO capacity; what should ECMO selection criteria be and how is it implemented; who should manage ECMO and maintenance of skills; and how governance is provided. We believe that ECMO should be a standard of care used to support carefully selected post-cardiotomy patients. A national policy should be developed for ECMO usage in non-ECMO units.