A heavy load
ECMO is the highest level of life support that can be provided, with a machine wholly or partly replacing the function of the patient’s own heart and/or lungs.
Only a small number of facilities in the world, and in Australia, are able to provide ECMO. In Australia, all ECMO services are located in large city intensive care units (ICUs), though some ECMO retrieval services can initiate ECMO support in smaller hospitals before moving patients to an ECMO ICU for ongoing care.
Highly specialised equipment and staff are required to provide ECMO.
Around-the-clock care is provided by highly trained ECMO nurses. Many ECMO ICUs have one nurse to look after the ECMO machine and another to look after the patient, who remains critically ill and usually on a full suite of other life support measures in addition to ECMO. These might include a ventilator to support the lungs, a dialysis machine to support the kidneys and many different types of drugs continuously delivered to keep the patient alive.
Medical care in the ICU is provided by large specialised teams. A broader allied health team including physiotherapists, dietitians, social workers and pharmacists help provide holistic care. Perfusionists, who specialise in extracorporeal life support, provide vital expert guidance.
Life-threatening problems with bleeding, clotting and infection are common when managing ECMO patients. Patients frequently require highly specialised support from cardiothoracic surgical teams, haematology and specialised blood bank services, radiology and interventional radiology, general surgical services, infectious diseases, cardiology, and respiratory medicine.
Some patients require weeks to months of ECMO support, which can raise ethical issues regarding resources, allocation and deaths. Some COVID patients are on ECMO for more than 100 days. The COVID pandemic has severely tested the ability of our health-care services to provide ECMO care.