Scotland sets up ECMO expert group
Health Secretary Nicola Sturgeon today announced the establishment of an expert group to consider the medium to long term provision of adult ECMO treatment in Scotland.
Scotland already has provision of ECMO for children and heart surgery patients. This group will consider the need for ECMO for adults who may require longer term critical care for the purpose of respiratory support.
Scotland’s current arrangements allow patients to receive ECMO treatment where clinically necessary. Scotland’s specialists liaise with UK colleagues in this field and work with the commissioned UK co-ordinating centre in Leicester and with similar European centres.
Treatments such as ECMO require major resource and input from specialist nursing, medical and technical personnel (eg blood transfusion and laboratory services). It is important that any decision made on future provision is not to the detriment of other services such as cardiac surgery.
The key remit of the expert group is:
* To consider the findings of the recent CESAR trial and previously published evidence for the use of ECMO in adults.
* To take evidence from leading experts regarding the efficacy and safety of ECMO treatment in adults.
* Having considered this evidence, to provide recommendations to the Cabinet Secretary for Health and Wellbeing regarding current and future ECMO provision in Scotland.
The Group will be Chaired by Dr Simon Mackenzie, President of the Scottish Intensive Care Society. Dr Mackenzie will be joined on the Group by a number of leading clinicians in this field from across Scotland.
Ms Sturgeon said:
“It’s important that we have adequate provision of ECMO across the UK. Evidence gathered by the expert group will help us reach decisions about increasing ECMO capacity in Scotland.
“However, it will take time to establish dedicated Scottish provision. Therefore I and Health Ministers across the UK have asked the UK Critical Care Group to advise us on what action requires to be taken in the short term to increase UK capacity to deal with the flu pandemic flu.”
ECMO provision costs in the region of around £100,000 per patient episode.
ECMO is used to treat respiratory or cardiac failure that is considered to have a reversible cause and is unresponsive to conventional intensive care procedures. In essence, ECMO takes over part of the body’s function to enable the heart and lungs to recover and heal.
ECMO is similar to a heart-lung bypass machine. The patient’s circulation is connected to an external pump and an artificial lung (oxygenator). A catheter placed in the right side of the heart carries blood to a pump, then to a membrane oxygenator, where exchange of oxygen and carbon dioxide takes place. The blood then passes through the tubing back to either the venous or arterial circulation. An anticoagulant is used to prevent the blood clotting.
Adults may receive ECMO for a variety of reasons including post cardiac surgery and the conditions that may cause Adult Respiratory Distress Syndrome (ARDS) for example sepsis. Common causes for ECMO treatment in neonates and children include meconium aspiration, cardiac and respiratory causes, infection, and congenital diaphragmatic hernia.
ECMO is a highly specialised technique demanding even higher levels of medical, nursing and technical/laboratory support than in Level 3 (ICU) facility. An ECMO service has to have access to a large range of skills including trained intensive care medical and nursing staff with specific expertise in ECMO, perfusionists, respiratory specialists, operating theatre support, laboratory services, physiotherapists and other physicians and surgeons as well as numerous other services.