CHEST Guidelines-Research-in-Extracorporeal-Life-Support_2018

Research-in-Extracorporeal-Life-Support_2018_chest

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This document is an editorial discussing the increasing use of Extracorporeal Life Support (ECLS) and the urgent need for research to support its application. ECLS encompasses techniques providing extracorporeal gas exchange or circulatory support for patients experiencing severe respiratory or cardiac failure. The use of ECLS in adults has surged, driven by advancements in cardiopulmonary bypass technology and events such as the H1N1 flu pandemic and supportive clinical trial outcomes for severe adult respiratory conditions.<br /><br />Despite its growing adoption, the evidence base for ECLS's effectiveness is lacking, with significant uncertainty about when it should be indicated and if it stands superior to current standard-care practices. This gap is attributed to heterogeneity in ECLS practices, logistical challenges in enrolling critically ill patients for research, limited research funding, and other external pressures that facilitate ECLS use yet hinder study initiatives.<br /><br />Addressing this demand for evidence necessitates strategic efforts to standardize and protocolize ECLS practices, prioritize research needs, and ensure focused and well-structured collaboration among international centers. The goal is to have robust evidence addressing when, how, and in which patient populations ECLS should be implemented, quantify its benefits, manage complications, and optimize resource allocation.<br /><br />Key recommendations include defining priorities and core datasets for ECLS research, encouraging cooperation among high-capacity ECLS centers through networks, and developing comprehensive databases for data collection and analysis. The involvement of multiple disciplines and the exploration of different research methodologies, including advanced predictive enrichment strategies and alternate trial designs, are also emphasized. <br /><br />These collaborations are crucial to shaping guidelines and policies that govern the optimal application of ECLS, securing its role in standard medical practice, and protective against its inappropriate use. Efforts to establish a multi-faceted approach to research will benefit from the support and collaboration of medical societies, funding agencies, and the ECLS community globally.

Keywords

Extracorporeal Life Support

ECLS research

cardiac failure

respiratory failure

standard-care practices

clinical trials

research collaboration

protocol standardization

data collection

predictive enrichment strategies