title: Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients.
abstract: The use of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory failure (ARF) in adults is growing rapidly given recent advances in technology, even though there is controversy regarding the evidence justifying its use. Because ECMO is a complex, high-risk, and costly modality, at present it should be conducted in centers with sufficient experience, volume, and expertise to ensure it is used safely. This position paper represents the consensus opinion of an international group of physicians and associated health-care workers who have expertise in therapeutic modalities used in the treatment of patients with severe ARF, with a focus on ECMO. The aim of this paper is to provide physicians, ECMO center directors and coordinators, hospital directors, health-care organizations, and regional, national, and international policy makers a description of the optimal approach to organizing ECMO programs for ARF in adult patients. Importantly, this will help ensure that ECMO is delivered safely and proficiently, such that future observational and randomized clinical trials assessing this technique may be performed by experienced centers under homogeneous and optimal conditions. Given the need for further evidence, we encourage restraint in the widespread use of ECMO until we have a better appreciation for both the potential clinical applications and the optimal techniques for performing ECMO.
authors: 1 Institute of Cardiometabolism and Nutrition, Groupe Hospitalier Pitié-Salpêtrière, Pierre Marie Curie University, Paris, France.
authors: Alain
authors: A
authors: Combes
authors: Daniel
authors: D
authors: Brodie
authors: Robert
authors: R
authors: Bartlett
authors: Laurent
authors: L
authors: Brochard
authors: Roy
authors: R
authors: Brower
authors: Steve
authors: S
authors: Conrad
authors: Daniel
authors: D
authors: De Backer
authors: Eddy
authors: E
authors: Fan
authors: Niall
authors: N
authors: Ferguson
authors: James
authors: J
authors: Fortenberry
authors: John
authors: J
authors: Fraser
authors: Luciano
authors: L
authors: Gattinoni
authors: William
authors: W
authors: Lynch
authors: Graeme
authors: G
authors: MacLaren
authors: Alain
authors: A
authors: Mercat
authors: Thomas
authors: T
authors: Mueller
authors: Mark
authors: M
authors: Ogino
authors: Giles
authors: G
authors: Peek
authors: Vince
authors: V
authors: Pellegrino
authors: Antonio
authors: A
authors: Pesenti
authors: Marco
authors: M
authors: Ranieri
authors: Arthur
authors: A
authors: Slutsky
authors: Alain
authors: A
authors: Vuylsteke
mesh_terms: D000328:Adult; D000552:Ambulances / Q000458:organization & administration; D035843:Biomedical Research; D003422:Critical Care / Q000379:methods / Q000458:organization & administration*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D006801:Humans; D016730:Program Development; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D062606:Tertiary Care Centers / Q000458:organization & administration*; D014187:Transportation of Patients / Q000379:methods / Q000458:organization & administration
keywords: acute respiratory distress syndrome; critical care networks; extracorporeal membrane oxygenation; hospital organization; position article