Management of Emergencies in Patients on Extracorporeal Membrane Oxygenation
The British societies guideline on management of emergencies on ECMO. This is a unique collaboration between all UK ECMO centres and eight national societies.
Abstract
Extracorporeal membrane oxygenation (ECMO) is providing an increasingly important therapy for patients in severe heart and lung failure. Care of these patients is complex, with changes in circulation that mean standard advanced life support algorithms may not always be applicable. Through collaboration between all UK ECMO centres and eight national societies, we have assessed the current evidence base and, using a modified Delphi process, produced national guidelines on the management of emergencies on ECMO. The guidelines focus on the recognition of cardiac arrest, team prioritisation, and early ECMO troubleshooting for key life-saving interventions. The guidelines are applicable to all staff and types of ECMO performed in the UK and should be utilised in conjunction with appropriate training. In summary, the joint British societies and ECMO centres working group present the UK guideline for the management of emergencies in ECMO.
UK multisociety consensus statement on the emergency management and resuscitation of patients with left-sided Impella support
The British societies guideline on management of emergencies on ECMO. This is a unique collaboration between all UK ECMO centres and eight national societies.
Abstract
The use of left-sided Impella microaxial flow pumps has expanded rapidly for the management of cardiogenic shock, left ventricular unloading and as a bridge to heart transplantation. However, standard life support and resuscitation algorithms are not directly applicable to patients receiving this therapy due to fundamental alterations in circulatory physiology. To address this gap, eleven UK Impella centres and eight national professional societies collaborated to develop a unified national consensus statement on the emergency management of patients with left-sided Impella support. Using a systematic review of the literature and a modified Delphi process guided by the European Society of Cardiology framework for grading recommendations, expert representatives achieved agreement on key priorities and structured actions to be undertaken in the first few minutes of resuscitation.
The consensus outlines early recognition of circulatory inadequacy (mean arterial pressure <30 mm Hg or end-tidal CO₂ <2 kPa), prompt activation of multidisciplinary responders, reduction of Impella power to P2 before initiating cardiopulmonary resuscitation and structured division of patient-focused and device-focused teams. Device-specific troubleshooting algorithms are presented for suction, malposition, purge-system failure and mechanical malfunction. This multisociety consensus represents the first national standard for emergency management and resuscitation of patients supported by a left-sided Impella device and is intended to inform structured clinical training and improve patient outcomes through rapid, coordinated and physiologically tailored interventions.
Publication from the BMJ Journals
https://heart.bmj.com/content/early/2025/12/17/heartjnl-2025-326896