Extracorporeal membrane oxygenation in adults
Summary
The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on extracorporeal membrane oxygenation in adults.
NICE has been notified about further publication of literature on this procedure and will consider whether to review the current guidance as part of the Institute's work programme.
If this procedure meets the conditions to be re-assessed, the Interventional Procedures Advisory Committee (IPAC) will consider it and NICE will issue an Interventional Procedures Consultation Document about its safety and efficacy for 4 weeks public consultation. IPAC will then review the consultation document in the light of comments received and produce a Final Interventional Procedures Document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.
In the meantime, the NHS should continue to follow the recommendations in the guidance below.
If you wish to be alerted to developments regarding this procedure, including the release of the consultation document, please express your interest at the top of the page.
Description
Extracorporeal membrane oxygenation (ECMO) is indicated for respiratory or cardiac failure unresponsive to all other measures, but considered to have a reversible cause. Most people treated with ECMO are very seriously ill.
ECMO may also be used following heart surgery to ease the transition from cardiopulmonary bypass.
ECMO is a temporary life support technique. It involves connecting the internal circulation to an external blood pump and artificial lung. A catheter placed in the right side of the heart carries blood to a pump, then to a membrane oxygenator, where gas exchange of oxygen and carbon dioxide takes place. The blood then passes through tubing back into the patient's veins or arteries. Patients are given an anticoagulant, to prevent blood clotting in the external system. Bleeding is therefore a likely adverse effect. Others include blood infection and haemolysis (breaking up of blood cells).
The conventional alternative to ECMO involves maximal intensive care support without ECMO, including mechanical ventilation. Ventricular assist devices, which pump the blood externally but do not allow gas transfer, may be used in addition to standard ventilation, where circulatory rather than respiratory failure is prominent.
In babies under the age of 28 days with severe respiratory failure, ECMO has been shown to improve survival compared with conventional management.
OPCS code:
X58.1 Extracorporeal membrane oxygenation
The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS. The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided. www.connectingforhealth.co.uk/clinicalcoding
Details
Respiratory
Surgical procedures
Contact details:
(for general enquiries or comments)
Interventional Procedures Programme
National Institute for Health and Clinical Excellence
MidCity Place
71 High Holborn
London
WC1V 6NA
