Extra-corporeal membrane oxygenation for patients in Scotland with severe
respiratory failure is delivered by Critical Care in Aberdeen.
About the Service
NHS Grampian has provided ECMO for patients in Scotland since 2009 when it started working collaboratively with Glenfield Hospital in Leicester. It has been a part of the UK ECMO network since it was established in 2011.
It has been recognised as a Platinum Level Center of Excellence by the Extracorporeal Life Support Organisation (ELSO).
In April 2020 Aberdeen was officially commissioned as the sixth adult respiratory ECMO centre in the UK.
Referral Process
Clinicians seeking to discuss the role of ECMO for a patient, or to make a referral should do so via the Signpost Healthcare online system at https://www.signpost.healthcare/ecmo-referral-pathway Referrals will be notified to the team in Aberdeen and we will be in contact to discuss the case and develop a management plan.
If there are any problems using the portal or if you would like to discuss an emergency case, please feel free to contact our ECMO Coordinator on 01224 607018 or 07917068628.
For non-urgent enquires not relating to a referral you can contact us via our email address: gram.ecmo@nhs.scot
Referral Criteria
- Potentially reversible severe respiratory failure (e.g., PaO2/FiO2 <6.7 kPa for >= 3 hours or PaO2/FiO2 <10 kPa for >= 6 hours)
- Murray Lung Injury Score >= 3
- Uncompensated hypercapnia with a pH <= 7.20 / H+ >63.1 despite respiratory rate > 35/min or due to life threatening airway disease (e.g., asthma or airway trauma, air leak)
- Failed trial of ventilation in prone positioning >= 6 hrs (unless contraindicated)
- Failed optimal respiratory management with lung protective ventilation after discussion with a national ECMO centre
- Refractory or established multiorgan failure
- Evidence of severe neurological injury
- Prolonged cardiac arrest (> 15 min)
At least two ECMO centres must agree that it is appropriate to proceed to ECMO for patients meeting one of the following criteria:
- Indices of low potential to recover such as RESP Score <= 3
- Invasive mechanical ventilation > 7 days
Calculating the RESP Score
The RESP score is required as part of the referral information.
For the calculation of the RESP score:
- If COVID-19, aetiology will be “viral pneumonia”
- High-flow nasal cannula (HFNC) will NOT count towards ventilated days
- If on continuous positive airway pressure (CPAP) / non-invasive ventilation
(NIV) pre-intubation >1 day these days will count towards mechanical ventilation days if on average:
- CPAP/NIV used > 12 hours/day
- PaO2/FiO2 < 20 kPa with FiO2 > 60%
- And any of:
- PaCO2 < 4 kPa or respiratory rate > 25/min
- PaCO2> 6.5 kPa/increasing since CPAP/NIV
- Inspiratory tidal volume (if measured) > 9.5 ml/kg predicted body weight (PBW)
Retrieval Process
If your patient is accepted for ECMO, a team from Aberdeen will be dispatched to your hospital. The team will assess your patient and make a definitive decision for mobile ECMO. If mobile ECMO is required this will be instituted on-site prior to transfer back to Aberdeen.
Please see ECMO Cannulation and Retrieval Guide which gives further information and outlines the requirements.