ECMO Services in England | Last update 31st March 2020

 

This page is best viewed on a desktop or laptop

This page signposts referral pathways for ALL patients with acute severe respiratory failure who may need ECMO

including those with COVID-19. 

 Before seeking advice regarding a patient with suspected or confirmed COVID-19 please familiarise yourself with the latest guidance, advice and recommendations from the Faculty of Intensive Care Medicine here.


 

 

1

a. Download this file or copy and paste this red text into MS Notepad/ Word

b. complete ALL data fields. You will need this for step 2

2
i) Copy the completed Physiological and Treatment data from step 1 

ii) Click your region on the map to be directed to the appropriate ECMO service referral form

iii) Paste the completed Physiological and Treatment data into the 'History' box.




 

Parts of this process are temporary due to the current COVID-19 emergency and these steps will be streamlined in a matter of days.

Please bear with us while we finalise the national emergency ECMO referral pathway.
 

 

 

If you encounter any problems with this referral pathway then call switchboard and ask for the ECMO on-call doctor.

What happens next?

You will be notified by telephone and SMS alerts as to the progress of your referral. You will receive written advice from the Complex Respiratory/ECMO team which you can upload to your local EPR system or print and file in the notes.

 

Nationally there are five ECMO units.

 

Click to read more.

 

Royal Brompton & Harefield Hospital: London

Guy’s & St Thomas’ Hospital: London

Papworth Hospital: Cambridge

Glenfield Hospital: Leicester

Wythenshawe Hospital:  Manchester

 

Scotland
All referrals from Scotland should be made to Glenfield Hospital, Leicester. Following assessment/triage, admission would usually be to

the ECMO centre in Aberdeen.

Wales

All referrals from Wales should be made to Glenfield Hospital, Leicester.  Following assessment/triage, admission could be to any centre in the network.

Northern Ireland

All referrals from Norther Ireland should be made to Glenfield Hospital, Leicester. Following assessment/triage, admission could be to any centre in the network.

This process has been agreed and signed off by the five ECMO Centres and NHSE.

Parts of the below process are temporary due to the current COVID-19 emergency and these steps will be streamlined in a matter of days.

Please bear with us while we finalise the national emergency ECMO referral pathway.
 

If you encounter any problems with this referral pathway then call switchboard and ask for the ECMO on-call doctor.
 

 

Copy the red text below to MS Notepad/ Word, complete the questions then paste to the free text box labelled 'HISTORY' in referapatient.



PHYSIOLOGICAL & TREATMENT PARAMETERS

Body weight:     (kg)
Height:     (cm) 
or BMI:     (Kg/ m)

------------------------------------------------------------------------

REASONS FOR REFERRAL (incl. presenting symptoms and date of onset):
Date of Hospital Admission:
Date of Admission to ICU:
 
RESPIRATORY FAILURE RESULTING FROM:
1st diagnosis: (state Suspicion / Proven ? / Reversible)

If appropriate:
2nd diagnosis: (state Suspicion / Proven ? / Reversible)

------------------------------------------------------------------------

UNDERLYING RESPIRATORY FUNCTION:
Known underlying respiratory disease: YES/ NO
If yes, please give details:
 
CURRENT RESPIRATORY STATUS:
Number of days intubated:
Ventilation mode: 
Last ventilation parameters: 
Fi02: 
PEEP:           (cmH2O)
Rate:
Peak airway pressure:      (cmH2O) 
Tidal Volume:               (mls)
Last ABG: 
pH: 
PO2:         (kPa) 
PCO2:         (kPa) 
BE: 
SaO2:
HCO3: 
Lactates:         (mmol/L)
Chest X-Ray / CT scan description or report:

-----------------------------------------------------------------------

MURRAY SCORE

Calculate Murray Score

------------------------------------------------------------------------

ATTEMPTED TREATMENT:
Filters changed and ventilator circuit checked: YES/ NO
Steroids: YES/ NO
Inhaled vasodilators?: YES/ NO
High PEEP: YES/ NO
Lung-recruitment manoeuvres: YES/ NO
Prone positioning: YES/ NO
Oscillatory ventilation?: YES/ NO


------------------------------------------------------------------------


OTHER INFORMATION:
Any known condition or organ dysfunction that would limit the likelihood of overall benefit from ECMO (e.g. severe, irreversible brain injury or untreatable metastatic cancer): YES/NO

Known allergies:
Known or suspected pregnancy: YES/ NO
Severe immunosuppression: YES/ NO
If yes, give reasons:
Blood transfusion limitations (e.g. for religion, antibodies): YES/ NO
Limited vascular access: YES/ NO
Any condition that precludes the use of anticoagulants: (YES/ NO)
 
 
TEMPERATURE:
Highest Temperature:
Barrier nursing status:

If diagnosis unknown:
Recent travel: YES/ NO
If yes details:
Occupation:
Contact with animals: YES/ NO
Contact with other unwell persons: YES/ NO
Bleeding: YES/ NO
If yes details:
Rash: YES/ NO
If yes details:

  
ONGOING MEDICATIONS:

Antibiotics/Antivirals:

Inotropes /vasoactives:
Sedation/muscle relaxants:
Others:
Has sodium bicarbonate been administered: YES/ NO 
If yes, please give details:

BLOOD RESULTS OF INTEREST:
Last WBC:
Neutrophils %:
Peak WBC: 
CRP:
Procalcitonin:
Last haemoglobin:
Last platelet count:
Last creatinine:
Last urea:
Last bilirubin: 
Troponin: (state normal range in referring hospital: 
Vasculitis or auto-immune screen:
Others of interest: 

------------------------------------------------------------------------

ORGAN FUNCTION:
Cardiac function:
Heart rate/ rhythm:
Blood pressure: 
Known previous cardiac pathology?: YES/ NO
If yes details:
TTE/TOE done?: YES/ NO
Main findings:
 
RENAL FUNCTION:
CVVH: YES/ NO
If yes, what is the exchange rate: 
Known previous renal pathology?: YES/ NO
If yes details:
Fluid balance for last 3 days:

HEPATIC FUNCTION:
Known previous hepatic pathology?: YES/ NO
If yes details:
Neurological status:
Known previous neurological pathology?: YES/ NO
If yes details:

CONSENT:
Any known or suspected objection for ECMO from the patient or next of kin: YES/ NO

------------------------------------------------------------------------
INCLUSION CRITERIA:
Potentially reversible respiratory failure: YES/ NO
Severe respiratory failure, defined as a Murray score = 3: YES/ NO
Or
Uncompensated hypercapnoea with a pH < 7.20: YES/ NO

RELATIVE EXCLUSION CRITERIA:
High-pressure ventilation (plateau pressure > 30 cm H2O) for > 10 days: YES/ NO
High FIO2 requirements (>0.8) for > 10 days: YES/ NO
------------------------------------------------------------------------

END