ECMO referrals and transfer pathway

How to refer a patient for SARF/ECMO

Step 1: Download our referral form (doc, 539KB)

Step 2: Fill in the information, save the form as a PDF file and email to rbh-tr.ecmoreferral@nhs.net

Step 3: Call the Royal Brompton Hospital ECMO nurse on 07815 494 175  and state that you have referred a patient

Step 4: The ECMO consultant on call will contact the referring team and discuss 

If the patient's condition is time critical, please call the ECMO nurse on 07815 494 175 while filling in the referral form. 

Referral criteria

The general referring criteria are as follows:

  • Severe hypoxaemia (eg PaO2/FiO2 <13.3kPa)
  • Severe hypercapnic acidosis (eg pH <7.20)
  • Inability to achieve lung protective tidal volumes and pressures (tidal volume < 6ml/kg predicted body weight, plateau pressure <30cmH2O)
  • Failure to improve with rescue therapies such as high-frequencyoscillation and prone positioning
  • Significant air leak/bronchopleural fistula.

There are specific criteria for consideration of ECMO support based on the CESAR study and defined by NHS Specialised Services during the commissioning of ECMO capacity. 

Indications  Contraindications (relative)
  • Age ≥16 years
  • Potentially reversible severe acute respiratory failure
  • No limitation to on-going life-sustaining treatment 
  • Murray score ≥3.0 (consider referral is ≥2.5 and rapid clinical deterioration) OR
  • Uncompensated hypercapnoea with pH <7.20
  • Age >65 years
  • Intracranial bleed (current or recent) 
  • Other contraindications to heparinisation 
  • High pressure (peak inspiratory pressure >30 H2O and/or high FiO(>0.8) ventilation for more than seven days

Murray score

  0 1 2 3 4
P/F ratio (kPa) ≥40 30-39.9 23.3 – 29.9 13.3 – 23.2 <13.3
PEEP (cmH2O) ≤5 6-8 9-11 11-14 ≥15
Compliance (ml/cmH2O)* ≥80 60-79 40-59 20-39 ≤19
CXR quadrants infiltrated 0 1 2 3

4


*Compliance is calculated as  Tidal volume (ml) / (Pplat - PEEP) (mmH2O)

Final score = sum of all individual scores by the number of parameters shown 

Predicted body weight (PBW)

PBW in kg (males) = 50 + 0.91 x (Height in cm - 152.4)

PBW in kg (females) = 45.5 + 0.91 x (Height in cm - 152.4)

Target TV = 6ml/kg PBW

Height (cm) PBW (kg) in males  PBW (kg) in females
150 47.8 43.3
155 52.4 47.9
160 56.9 52.4
165 61.4 56.9
170 65.9 61.4

175

70.5 66.0
180 75.0 70.5
185 79.5 75.0
190 84.2 79.7

 


Transfer pathway for ECMO and severe respiratory failure service

The film below illustrates the process for transferring patients with severe acute respiratory failure who may be suitable for extracorporeal membrane oxygenation (ECMO). It is aimed at clinical staff including doctors, nurses, allied healthcare professionals, ambulance crews and managers who might be involved in caring for these critically ill patients pending transfer.

Any hospital considering referring a patient for ECMO should contact their local ECMO centre in the first instance.

This film was created by North West London Critical Care Network

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