Use of Extracorporeal Circulation (ECC) Outside the Cardiac Operating Room: Indications, Requirements and Recommendations for Routine Practice[*]

Background

The introduction of the heart-lung machine (HLM) in the 1950s, which first offered the possibility of establishing extracorporeal circulation (ECC), has resulted in open heart surgery becoming a routine procedure. This seminal development was followed by improvements to the HLM and its component parts. The impact of ECC on organs such as the kidney, lungs and brain has therefore been reduced to a minimum. Today, with modern monitoring and special cannulation techniques, technical complications have become extremely rare. The high standards achieved in the use of ECC are a result of the utilization of specially trained staff and the use of the latest technical advances for all components of the HLM.

Over time, miniaturization and technical innovations have led to the development of numerous mobile cardiovascular support systems (HLM, extracorporeal life support system [ECLS], extracorporeal membrane oxygenation [ECMO], etc.), which evolved from the original HLM and which are now also used outside the cardiac operating room. These cardiovascular support systems provide hemodynamic support to patients with advanced cardiovascular disease or suffering from protracted shock and/or are used to treat patients with refractory lung disease. Given the appropriate technical expertise and trained staff in attendance, these patients can be transported over long distances to suitable centers offering cardiac surgical care. Mobile systems offer greater circulatory stability than can be achieved with medication, or by the implantation of an intra-aortic balloon pump (IABP) or even by cardiopulmonary reanimation.

The use of ECC outside the cardiac operating room (which is equipped with all the necessary technical support equipment and staff) and the possibility of offering emergency intervention together with appropriate monitoring require special precautionary arrangements to guarantee the safety of the patient. If staff are not specially trained, the cannulation required to establish ECC and the use of ECC itself may result in life-threatening complications.

Thus, we considered it imperative to describe the mandatory technical and staffing requirements which will allow these advances in ECC technology to be implemented safely in routine clinical practice to the benefit of the patient.

The aim of this structure paper was to define the indications for the use of ECC together with the framework requirements. Moreover, recommendations regarding the use of ECC outside the cardiac operating room are also given.

1 First published in KARDIOTECHNIK 2010; 19 (3): 58–60

1 First published in KARDIOTECHNIK 2010; 19 (3): 58–60