Chest
Topics in Practice ManagementExtracorporeal Membrane Oxygenation*: Current Clinical Practice, Coding, and Reimbursement
Section snippets
Neonatal Respiratory Failure
Bartlett and colleagues4 reported the first case series of 28 patients (14 children, 14 adults) who were treated with ECMO in 1977. Although only 5 of 28 patients were long-term survivors, the early successes in near-moribund patients led to the first randomized trials of ECMO therapy for respiratory failure in neonates. The first of these trials used a nontraditional “play-the-winner” randomization technique, where the chance of assigning an infant to a treatment was influenced by the outcome
Respiratory Failure
Today, most current controversy surrounds the use of ECMO in adult patients with respiratory failure. The first randomized trial20 comparing patients in nine medical centers treated with ECMO or conventional ventilation was published in 1979. The survival rate in both groups was < 10%, and no significant difference in mortality was observed between patients receiving ECMO or conventional ventilation. ECMO proponents today point out that this study was performed in the early days of the field,
Emergent ECMO (Extracorporeal Cardiopulmonary Resuscitation)
ECMO has recently been used29 as a last means of resuscitation for patients undergoing CPR. Extracorporeal cardiopulmonary resuscitation has recently been demonstrated30 to be associated with survival rates to hospital discharge of 34 to 38% in pediatric patients. Similar results have been seen in adult patients among whom survival rates of 38% have been reported.14 Although survival rates in patients undergoing extracorporeal cardiopulmonary resuscitation are not as high as for other ECMO
Bedside Management
ECMO is an intensive therapy with a learning curve in its application,22 and its practice is best suited to centers where the expertise exists in daily management. For this reason, regionalization is appropriate to ensure that adequate volumes are present at each ECMO center. Given the acuity of care and the risk of sudden decompensation if the circuit fails, special training is mandatory for physicians, nurses, respiratory therapists, and patient care technicians providing care to ECMO
Coding and Documentation
Current procedural terminology (CPT) codes31 and relative value units32 for ECMO cannulation and management are listed in Table 2. Charge and reimbursement for ECMO services will vary based on provider and payer, respectively. CPT code 36822 covers ECMO cannulation. This code is the same regardless of whether cannulation occurs via the VA or VV approach and regardless of whether the vasculature is cannulated through the chest, neck, or groin. The code also makes no distinction between open and
Conclusion
ECMO is currently being used in ICUs worldwide for neonatal, pediatric, and adult respiratory and cardiac failure. Evidence to support its use is strongest in the neonatal population, but treatment in the pediatric population is also generally accepted. The usage of ECMO in cases of adult respiratory failure is currently controversial, although the promising results of the Conventional Ventilation or ECMO for Severe Adult Respiratory Failure (or CESAR) trial (which await publication in the
Acknowledgment
We thank the Office of Physician Billing Compliance for helpful suggestions and for critical review of this manuscript.
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Cited by (79)
The Atrial Flow Regulator: A Novel Device for Left Ventricular Unloading in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation Support?
2021, ChestCitation Excerpt :Urgent heart transplantation was now unlikely, and therefore the patient benefited from a biventricular assistance device (Berlin Heart) combined with extraction of the AFR device, 6 days after the procedure (Fig 1F). VA ECMO is the preferred mechanical support for patients in cardiogenic shock with biventricular failure, allowing tissue perfusion as a bridge to recovery with long-term mechanical circulatory support, or transplantation.3-5 However, retrograde flow from the femoral artery can induce increased afterload, left ventricular distension, and severe pulmonary edema.
Long-term neurologically intact survival after extracorporeal cardiopulmonary resuscitation for in-hospital or out-of-hospital cardiac arrest: A systematic review and meta-analysis
2020, Resuscitation PlusCitation Excerpt :Extracorporeal cardiopulmonary resuscitation (ECPR), or cardiopulmonary resuscitation (CPR), assisted by veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a method of temporary mechanical circulatory support based on utilization of an extracorporeal membrane oxygenation (ECMO) system.1–3
Salvage thrombolysis and extracorporeal membrane oxygenation for massive pulmonary embolism during the distal femur fracture surgery
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2016, Nunn's Applied Respiratory PhysiologyPediatric Extracorporeal Membrane Oxygenation: An Introduction for Emergency Medicine Physicians
2015, Journal of Emergency MedicineCitation Excerpt :This success was attributed to the fact that in neonatal respiratory failure, the lungs require only a short time for recovery (9). Subsequently, ECMO has been used in NICUs for the treatment of respiratory failure due to primary pulmonary hypertension of the newborn, meconium aspiration syndrome, persistent fetal circulation, and congenital diaphragmatic hernia, yielding survival rates of >80% (10). From the success in neonates, and supported by good evidence-based medicine for treatment of respiratory failure, the technology was adapted to pediatrics in the early 1980s.
Acute compartment syndrome after extracorporeal membrane oxygenation
2015, Journal of Orthopaedic Science
The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
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