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Absence of written guidelines in neonatal units for ECMO referral may delay referral
  1. WILL CARROLL, Specialist Registrar
  1. Department of Paediatrics
  2. City General Hospital, Stoke-on-Trent, UK
  3. ECMO Coordinator
  4. Heartlink ECMO Office
  5. The Glenfield Hospital NHS Trust
  6. Groby Road, Leicester LE3 9QP, UK
    1. HILLARY KILLER
    1. Department of Paediatrics
    2. City General Hospital, Stoke-on-Trent, UK
    3. ECMO Coordinator
    4. Heartlink ECMO Office
    5. The Glenfield Hospital NHS Trust
    6. Groby Road, Leicester LE3 9QP, UK

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      Editor—Extracorporeal membrane oxygenation (ECMO) is a complex technique for providing life support in respiratory failure. ECMO support has been shown to be both clinically1 and economically2 justifiable for mature newborn infants with severe respiratory failure. As a result of the UK trial, the Department of Health (England and Wales) has decided to fund centrally three centres to provide an ECMO service for these children. Prompt and appropriate referral is essential to maximise the potential benefits from ECMO. Recent data have shown that the success of ECMO is inversely associated with the number of days pre-ECMO ventilation.3 It is vital that information regarding eligibility for ECMO referral, and contact numbers for referral should be readily available.

      In the past, guidelines in the form of a brief pamphlet giving information about the service have been circulated to regional neonatal units and special care baby units. We decided to ascertain what was known about the service we offered.

      We undertook a simple postal questionnaire survey of all 238 neonatal intensive care units and special care baby units in England, Northern Ireland, and Wales. This asked whether written guidelines for ECMO referral were available on their unit. If these were, then the respondents were asked to send a photocopy of these with the reply in the accompanying stamped addressed envelope.

      We had a high response rate, with 162 completed replies (71% response rate) within six weeks of posting. However, only 20 units had guidelines for ECMO referral (12.3% of responders). The potential delay that this may cause has obvious clinical implications. It is estimated that 100 to 200 neonates per year will benefit from ECMO. The neonatal ECMO trial established the following criteria for referral:

      • Oxygenation index >40

      • Gestational age >34 weeks

      • Weight >2 kg

      • Reversible lung disease (<10 days high pressure ventilation)

      • No major (> grade 1) intracranial haemorrhage

      • No lethal congenital abnormalities

      • If in doubt discuss with your nearest ECMO centre.

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      Contact telephone numbers:

      Glenfield Hospital, Leicester: 0116 287 1471 and ask for the ECMO coordinator.

      Great Ormond Street, London: 0171 405 9200 and ask for Cardiac ICU.

      Freeman Hospital, Newcastle-upon-Tyne: 0191 284 3111 and ask for Paediatric ICU.

      References

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