Coordinating an ECMO service with retrieval

Since the H1N1 influenza pandemic of 2009 there has been a dramatic increase in the number of patients receiving ECMO and in the number of hospitals that provide it. Data from the Extracorporeal Life Support Organisation (ELSO) suggests that over the last decade the number of adult patients receiving ECMO for respiratory support has increased at least 12-fold and the number of centres submitting data to the ELSO registry has tripled.  The approach to the provision of ECMO in NZ and Australia has been very different, with Australia seeing a huge increase in the number of ECMO centres since 2009 (there are now at least 17 centres in Australia) whilst NZ has continued to have a single national service based in Auckland.  Multiple studies suggest a significant outcome benefit for patients treated at high-volume ECMO centres (defined as those with >30cases per year) compared with "occasional" users and guidelines from the UK, NZ and elsewhere recommend that its use be restricted to expert centres that integrate ECMO within a specialist service providing care for patients with severe acute lung disease that have the capacity to transport these patients safely on ECMO if required.  This session will discuss the evidence for the perceived "volume effect" and the challenges of providing a comprehensive retrieval service.