AANA Journal Course--Initiation and Anesthetic Management of ECMO in the Adult Noncardiac Surgical Patient

The use of extracorporeal membrane oxygenation (ECMO) in surgical patients is increasing worldwide. Utilization of ECMO has nearly doubled in the past decade, enabling survival for 67% of patients in need of ECMO support. Induction and management of general anesthesia in the adult noncardiac surgical patient can present distinct challenges to the anesthesia practitioner's skill set. The need for alternative ventilatory and hemodynamic management strategies to support general anesthesia is indicated when challenges arise in the unstable surgical patient. ECMO support may be required to safely proceed with surgery in those instances. The rapid evolution of ECMO use in adult noncardiac surgical patients and a lack of updated clinical practice guidelines describing perioperative ECMO initiation and management create a knowledge gap among anesthesia practitioners. Resolving this knowledge deficit ensures efficacious care for this patient population at increased risk for perioperative complications and demise. This journal course will present evidence-based clinical practice recommendations to guide anesthesia practitioners on the initiation of elective preinduction and emergent ECMO support, and the considerations for intraoperative management of the adult noncardiac surgical patient on ECMO.