Extracorporeal membrane oxygenation for severe acute respiratory failure in adults

Evidence on the safety of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory failure in adults is adequate but shows that there is a risk of serious side effects. Evidence on its efficacy is inadequate to draw firm conclusions: data from the recent CESAR (conventional ventilation or extracorporeal membrane oxygenation for severe adult respiratory failure) trial was difficult to interpret because different management strategies were applied among many different hospitals in the control group and a single centre was used for the ECMO treatment group. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and research.

Clinicians wanting to do ECMO for severe acute respiratory failure in adults should:

• Inform the clinical governance leads in their trusts.

• Whenever possible, ensure that patients and their carers understand the uncertainty about the procedure's efficacy and its risks and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.

Extracorporeal membrane oxygenation for severe acute respiratory failure in adults should only be carried out by clinical teams with specific training and expertise in the procedure.

Clinicians are encouraged to submit data on all adults undergoing ECMO for severe acute respiratory failure to the Extracorporeal Life Support Organization Registry.

NICE encourages further research into the use of innovative technologies for the management of severe acute respiratory failure, and may review this guidance on publication of further evidence.