Extracorporeal membrane carbon dioxide removal
This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/ipg428
This document replaces previous guidance on extracorporeal membrane carbon dioxide removal (interventional procedure guidance 250).
1.1 Current evidence on the safety of extracorporeal membrane carbon dioxide removal (ECCO2R) shows a number of well-recognised complications. Evidence on its efficacy is limited in quality and quantity. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
1.2 Clinicians wishing to undertake ECCO2R should take the following actions.
Inform the clinical governance leads in their trusts.
Ensure that patients (if possible) and their families or carers understand the uncertainty about the procedure's efficacy and the risk of complications and provide them with clear written information. In addition, the use of NICE's information for patients (Understanding NICE guidance) is recommended. Audit and review clinical outcomes of all patients having ECCO2R (see sections 1.4 and 3.1).
1.3 ECCO2R should only be used by specialist intensive care teams trained in its use. Only patients with potentially reversible hypercarbic respiratory failure or those being considered for lung transplantation should be selected for this procedure.
1.4 NICE encourages clinicians to enter patients into ongoing trials and collaborate in data collection initiatives, such as the Extracorporeal Life Support Organization (ELSO) register. Studies should specify the type of technique being used. Data collected for research and for other clinical purposes should document patient selection criteria, thresholds for intervention, and the procedure's clinical benefits. NICE may review the procedure on publication of further evidence.