Friday, 1 December 2017

ECMO for refractory cardiac arrest: the Sydney experience

“Our study is the first multicentre study of ECPR outcomes in Australia. Thirty-seven patients between 2009 and 2016 underwent ECPR across two ECMO referral centres, with an overall survival rate of 35%, and excellent neurologic outcomes in survivors.”

Sounds great. Sign me up for ECMO!!!

But is there a downside?

This audit and medical record review took place over 7 years at two busy Sydney ED’s with a catchment area of 7 million. Both hospitals had developed ECMO response teams consisting of cardiothoracic surgery, anaesthetics, perfusionist and ICU personnel.

In the end, they had 13 good outcomes.

So, about 1 patient per year in each hospital…

In a system with limited healthcare resources, could these efforts been put to better use?

(Of course, ECMO can be used in other circumstances; support of cardiogenic shock post ROSC, overdose, hypothermia, etc.)

It is reasonable to conclude that ECMO currently is not ready for prime time in most centres. But perhaps we are in the ECMO infancy and it will become more feasible and important as the technology improves.

What do we conclude?

The current state of ECMO requires a lot of buck for little bang. It requires many resources and may have a role in the rare highly selected patient. But watch this space…

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