ECMO National Referral Pathway | Last update 30th June 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 five commissioned centres in England 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.

Referral criteria 
The ICNARC report on COVID-19 in critical care suggests that those who have so far become the most unwell as a result of COVID-19 are often not suitable for ECMO due to underlying health problems and co-morbidities. However, patients who meet the following clinical criteria may be considered suitable for ECMO support. 

 

Inclusion Criteria

(*revised in response to the COVID-19 pandemic)


• Potentially reversible severe respiratory failure
• Lung Injury Score ≥3 or uncompensated hypercapnia with a pH 7.20 or less
• Failed trial of ventilation in prone positioning ≥ 6 hrs (unless contraindicated)
• Failed optimal respiratory management / lung protective ventilation
• Clinical Frailty Scale category ≤ 3
• If RESP Score ≤ 3 ECMO should be considered only after agreement across at least two centres 

 
Exclusion Criteria

• Refractory multiorgan failure
• Evidence of severe neurological injury 

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

 

Additional Information

Click to visit each ECMO centres' web page.

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.

 

North Wales

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

South Wales

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.

Northern Ireland

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

 

You can read the full NHS ECMO document from the NHSE Covid-19 webpage here: