Outcomes after ECMO for acute heart failure

Dr Aidan Burrell, Monash University

2020 Postdoctoral Fellowship

Years funded: 2021-2022

Acute heart failure and cardiac arrest are major public health problems in Australia. Each year 1000s of such patients will die, and many others are left with significant disabilities. Extracorporeal membrane oxygenation (ECMO) is a novel form of advanced mechanical cardiac support used in the sickest of these patients. In selected patients, it can be lifesaving. However, it remains a high-risk and costly intervention, costing over AU$300,000 on average per hospital admission. Furthermore, its use has doubled over the last five years despite limited evidence supporting its use. Systematically developing robust, high-quality, patient-centred evidence to define the role of ECMO in acute heart failure and cardiac arrest is an urgent issue of national and international importance.

My fellowship aims to generate high-quality, clinically relevant, feasible and accessible knowledge to inform global practice of ECMO by addressing 3 major evidence-practice gaps:

1. Who will derive the best long-term benefit from ECMO? Currently patient selection for ECMO is based predominantly on short-term hospital survival. There is an urgent need to look at long term survival after ECMO, to inform which patients will benefit, while also preventing costly futile use.
2. How can we deliver ECMO more safely? ECMO provides high doses of oxygen (hyperoxia) to patients, however a growing body of evidence suggests hyperoxia may be harmful. Embedded within a multicentre RCT, I will look at the underlying biological effects of hyperoxia during ECMO.
3. Developing standard outcome measures for ECMO research: Currently many ECMO studies report different outcomes and complications, making it difficult to compare studies and inform clinical practice.

Building on recently published work defining important core outcomes in ECMO, I will lead an international collaboration to develop measurement tools for a core outcome set.