Regionalisation of Intensive Care and Extra-Corporeal Membrane Oxygenation Services in the UK: Beliefs about the Evidence, Benefits and Harm

Abstract

Extra-corporeal membrane oxygenation (ECMO) is used as rescue therapy for adults with severe acute respiratory failure. We aimed to determine the views of intensive care clinicians on regionalisation of critical care services and on the development of adult ECMO services in the UK. A survey was undertaken of all members of the UK Intensive Care Society; 2,133 participants were invited to complete the survey and 691 responded (32.7%). Among respondents, 65% believed that adult ECMO services should be expanded, 42.5% agreed that intensive care services in the UK should be regionalised, while 63.8% agreed the UK should develop regional ventilatory care centres including ECMO services. Experience during H1N1 influenza pandemics was the factor respondents most frequently identified as driving ECMO expansion (61.1%). Of respondents, 60.1% believe that an expanded ECMO service should be provided in 5–10 supra-regional centres. Patient safety, resources, guidelines and transportation of sick patients were also seen as important issues. We conclude that there is a reasonable level of support for regionalisation of intensive care services and for expansion in ECMO services for adults with severe acute respiratory failure in the UK. Clinicians support appropriate funding, investment in transport services and the development of national guidelines.