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Vol. 68. Issue 8.
Pages 443-471 (October 2021)
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Vol. 68. Issue 8.
Pages 443-471 (October 2021)
CONSENSUS STATEMENT
DOI: 10.1016/j.redare.2020.12.002
SEDAR/SECCE ECMO management consensus document
Documento de consenso SEDAR/SECCE sobre el manejo de ECMO
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I. Zarragoikoetxeaa,
Corresponding author
iratxezarra@gmail.com

Corresponding author.
, A. Pajaresa, I. Morenoa, J. Portaa, T. Kollerb, V. Cegarrab, A.I. Gonzalezc, M. Eirasd, E. Sandovale, J. Aurelio Sarraldef, B. Quintana-Villamandosg, R. Vicente Guilléna
a Servicio de Anestesiología y Reanimación, Hospital Universitari i Politècnic La Fe, Valencia, Spain
b Servicio de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
c Servicio de Anestesiología y Reanimación, Hospital Puerta de Hierro, Madrid, Spain
d Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Santiago, La Coruña, Spain
e Servicio de Cirugía Cardiovascular, Hospital Clínic de Barcelona, Barcelona, Spain
f Servicio de Cirugía Cardiovascular, Hospital Universitario Marqués de Valdecilla, Santander, Spain
g Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Tables (18)
Table 1. Grade system.
Table 2. Indications and contraindications for ECMO.
Table 3. Recommendations for cannulation.
Table 4. Recommendations for the implantation of ECMO in ARDS.
Table 5. General recommendations for the management of ECMO in ARDS.
Table 6. Recommendations for the implantation of ECMO in postcardiotomy shock.
Table 7. Recommendations for the use of ECMO in organ donation.
Table 8. Recommendations for the implantation of ECMO in primary heart graft dysfunction.
Table 9. Recommendations for the implantation of ECMO as a bridge to lung transplantation.
Table 10. ECMO in non-cardiac surgery.
Table 11. General recommendations for surgery/procedures in patients with ECMO.
Table 12. Recommendations for anticoagulation and thrombosis prevention in ECMO.
Table 13. Recommendations for the management of bleeding in ECMO.
Table 14. LV unloading techniques.
Table 15. Invasive LV unloading: risks and benefits.
Table 16. Oxygenation and perfusion monitoring.
Table 17. Echocardiographic planes.
Table 18. Recommendations for ECMO weaning.
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Abstract

ECMO is an extracorporeal cardiorespiratory support system whose use has been increased in the last decade. Respiratory failure, postcardiotomy shock, and lung or heart primary graft failure may require the use of cardiorespiratory mechanical assistance. In this scenario perioperative medical and surgical management is crucial.

Despite the evolution of technology in the area of extracorporeal support, morbidity and mortality of these patients continues to be high, and therefore the indication as well as the ECMO removal should be established within a multidisciplinary team with expertise in the area.

This consensus document aims to unify medical knowledge and provides recommendations based on both the recent bibliography and the main national ECMO implantation centres experience with the goal of improving comprehensive patient care.

Keywords:
ECMO
Perioperative
Respiratory failure
Cardiogenic shock
Transplantation
Complications
Resumen

La ECMO es un sistema extracorpóreo de asistencia cardiorrespiratoria cuya utilización se ha visto incrementada en la última década. La insuficiencia respiratoria, el shock postcardiotomía y el fallo primario del injerto cardiaco o pulmonar son complicaciones que pueden requerir la utilización de asistencia mecánica cardiorrespiratoria y en este escenario el conocimiento de las peculiaridades perioperatorias médicas y quirúrgicas es fundamental.

A pesar de la evolución tecnológica en el área de la asistencia extracorpórea la morbimortalidad de estos pacientes continúa siendo elevada, por lo tanto, la decisión del implante de la ECMO como la de su retirada debe establecerse dentro de un equipo multidisciplinar experto en el área.

El presente documento de consenso pretende unificar conocimientos y aportar recomendaciones basadas tanto en la bibliografía reciente como en la experiencia de los principales centros nacionales implantadores de ECMO con el objetivo final de mejorar la atención integral al paciente.

Palabras clave:
ECMO
Perioperatorio
Insuficiencia respiratoria
Shock cardiogénico
Trasplante
Complicaciones

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