ECMO National Referral Pathway | Last update 20th November 2020
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.
There are six commissioned centres in the United Kingdom for the provision of ECMO, each working to a specified geographical area (detailed here). However, in order to manage service demand, following assessment and triage, admission may take place at any of the designated centres. We have a unified national referral pathway.
Respiratory ECMO is indicated for acute severe but potentially reversible respiratory failure. It is therefore expected that the service will experience increased demand in response to patients with COVID-19. Given the more recent national and international evidence that suggests that severe
respiratory failure from COVID-19 carries the same prognosis as other aetiologies, the ECMO criteria should be common to severe ARDS from all aetiologies including COVID-19. Referrals to the service should be made by adult intensive care units for patients who are critically ill who are receiving lung protective mechanical ventilation or for patients in whom lung protective ventilation is not possible due to the severity of hypoxaemia/hypercapnia.
Inclusion Criteria for referral (in bold) and additional considerations for ECMO in all patients regardless of aetiology:
• Potentially reversible severe respiratory failure (e.g., PaO2/FiO2 <6.7 kPa for ≥3 hours or PaO2/FiO2 <10 kPa for ≥ 6 hours)
• Murray Lung Injury Score ≥3
• Uncompensated hypercapnia with a pH ≤ 7.20 despite respiratory rate > 35/min or due to life threatening airway disease (e.g., asthma or airway trauma, air leak)
• Failed trial of ventilation in the prone position for ≥ 6 hrs (unless contraindicated)
• Failed optimal respiratory management with lung protective ventilation after discussion with a national ECMO centre.
• Refractory or established multiorgan failure
• Evidence of severe neurological injury
• Prolonged Cardiac arrest (> 15 min)
Additional considerations by the ECMO centres:
At least two ECMO centres must agree that it is appropriate to proceed to ECMO for patients meeting one of the following criteria:
- Indices of low potential to recover such as RESP Score ≤ 3
- Receiving invasive mechanical ventilation > 7 days
For the calculation of RESP score:
- If COVID-19, aetiology will be “viral pneumonia”
- High-flow nasal cannula (HFNC) will NOT count towards ventilated days
- If on continuous positive airway pressure (CPAP)/non-invasive ventilation (NIV) pre-intubation >1 day – these days will count towards mechanical ventilation days if – on average:
- CPAP/NIV used > 12 hours/day
- PaO2/FiO2 < 20 kPa with FiO2 > 60%
- PaCO2 < 4 kPa or respiratory rate > 25/min; or PaCO2> 6.5 kPa/increasing since CPAP/NIV; or inspiratory tidal volume (if measured) > 9.5 ml/kg predicted body weight (PBW).
Watch this video on how to make a referral
referapatient® is a secure multimedia Clinical Information Exchange for closed loop communication. It acts as a digital bridge between healthcare organisations. This system will allow all the ECMO centres to collaborate, share referrals and capacity in real time.
referapatient can be accessed on any device, regardless of location and there is a 24/7 Helpdesk function on the page. Users will only require an nhs.net or Trust email address to access the system. No specific training is required. A documented outcome to the referral will be available to print or upload to your local EPR system.
Further details about referapatient® can be found here: www.bloomsburyhealth.org/referapatient
If you encounter any problems with this referral pathway then call switchboard and ask for the ECMO on-call doctor.
To make a referral click your region on the map below
Click to visit each ECMO centres' web page.
Direct Dial 07815 494 175 if problems using referapatient
Direct Dial 02071 882 511 if problems using referapatient
Direct Dial 01223 638 000 if problems using referapatient
Glenfield Hospital: Leicester
Call 03003 003 200 and ask for ECMO coordinator if problems using referapatient
Wythenshawe Hospital: Manchester
Direct Dial 0783 754 1143 if problems using referapatient
To refer click here
Aberdeen Royal Infirmary
Direct Dial 01224 607018 if problems using referapatient
All referrals in Scotland should be made to Aberdeen Royal Infirmary using the map above to access the referral form.
All referrals from North Wales should be made to Wythenshawe Hospital, Manchester. Following assessment/triage, admission could be to any centre in the network.
All referrals from South Wales should be made to St Thomas' Hospital, London. Following assessment/triage, admission could be to any centre in the network.
All referrals from Northern Ireland should be made to Glenfield Hospital, Leicester. Following assessment/triage, admission could be to any centre in the network.