Tuesday, 27 March 2018

Guiding use of one of the most expensive diagnostic tools in Australia

A/Prof Carol Hodgson has been busy co-authoring on a major position paper published in Intensive Care Medicine recently. Carol sits on both the Scientific and the Executive committees of the International ECMO Network, and was part of an international, multidisciplinary group asked to contribute their expertise to this publication.

Extracorporeal Membrane Oxygenation (ECMO) involves mechanical oxygenation of blood which is pumped out the body and into an ECMO machine. The machine removes carbon dioxide, adds oxygen, and then pumps it back into the patient.  It’s often a last-ditch treatment for critically ill people with acute respiratory or cardiac failure, where mainstream life support has failed.

ECMO for severe acute cardiac failure is in the top 3 most expensive diagnosis-related groups in Australia, costing $243,929 per complex admission. In five years the use of ECMO for severe cardiac failure and cardiac arrest has doubled both in Australia and globally and is used at an increasing number of centres without key information about best practice or patient outcomes. 
A/Prof Hodgson

Hospitals have generally welcomed ECMO, both as a strategy to save lives and in part due to generous government compensation schemes. Despite this, it’s an area that is extremely difficult to research, and evidence of effectiveness from randomised control trials (RCTs) is scant. The difficulties arise due to the life-threatening illness of patients requiring ECMO, as it is almost impossible to randomise these people into a trial that includes a control arm (no ECMO).

The position paper is an important first step and outlines a structured research agenda for the future– it includes consensus and advice from leading international ECMO experts. The paper focusses solely on individuals with veno-arterial failure, or acute heart failure. Major recommendations focussed on:

  • Appropriate patient selection
  • Organisation of ECMO centres to ensure adequate coverage
  • Appropriate patient transport to ECMO centres
  • Facilities required of ECMO centres
  • Training and education of staff
  • Future research