Extracorporeal Membrane Oxygenation (ECMO)

Making a referral

Before making your referral, please read the national referral criteria and guidance. 

You can make referrals for ECMO at Barts Health on the Signpost website. 

After you have made your referral, we will review it and our on-call ECMO consultant will contact you to discuss; please include a telephone number in the referral form to enable us to call you. The ECMO consultant will contact you as soon as is feasible following receipt of a referral, usually within 30 minutes.

If your referral is time critical, please contact the Barts Health ECMO consultant directly on 0203 596 0440.

What to expect as a referrer

We offer a consultant-delivered advice and retrieval service, including mobile ECMO, 24/7. If ECMO is to be instituted at the referring hospital, the ECMO retrieval team may need access to a radiographer with image intensifier, ultrasound equipment and two units of blood. The patient’s relatives should be asked to be available for discussion about ECMO with the ECMO team. Rarely, we may not have the capacity to accept patients to St Bartholomew’s Hospital. We would then liaise with other ECMO centres to arrange onward referral to include the Barts Health ECMO team taking a patient to another ECMO centre.

Patients who recover and no longer require specialist care for their severe lung failure may be referred back to their local hospital to allow them to be closer to friends and family and any ongoing clinical and service needs they may have. 

Our service includes emergency access to a 24/7 team of multidisciplinary specialists who can offer advice on patient management including transfer to St Bartholomew’s Hospital for expert acute cardiac care.

For further information or to refer a patient, please visit our Sharepoint webpage or visit the Barts Health Cardiogenic Shock webpage.

If your referral is time critical, please contact the Barts Health ECMO consultant directly on 0203 596 0440.

What is respiratory/lung ECMO?

ECMO is a specialist life support machine that can temporarily support or replace the function of the lungs and or the heart. Our lungs normally absorb oxygen from the air we breathe and get rid of a waste gas called carbon dioxide. Severely damaged lungs are unable to absorb enough oxygen into the blood and get rid of enough carbon dioxide – a situation that can become life threatening. ECMO does the work of the lung, allowing the lungs to rest and hopefully heal. Blood is pumped via plastic tubes from veins in the groin or neck to an artificial lung (called the membrane oxygenator). This artificial lung adds oxygen to the blood and removes the waste carbon dioxide. The blood is then returned to the patient via another tube in a large vein.

What is cardiac/heart ECMO?

We also offer cardiac ECMO to support severe acute heart failure. This is similar to respiratory ECMO but in addition to lung support, it can replace most of the blood flow from the heart to ensure vital organs receive oxygen and nutrients. In cardiac ECMO the blood is removed from a vein in the groin and returned to an artery in the groin. The most common reason for cardiac ECMO is cardiogenic shock due to a severe heart attack but there are many other causes of acute severe heart failure that can affect people of all ages including those without known heart diseases.

Why is ECMO being considered?

People who need ECMO have severe or life-threatening illnesses that prevent their lungs or heart from working properly. Most patients who need ECMO are already connected to a breathing machine (mechanical ventilator) and are being cared for in an intensive care unit. Your relative or friend has been referred to us because their lungs or heart are severely damaged. The doctors and nurses have asked whether ECMO might help them to recover. When our team arrives at the local hospital, we will carefully assess the patient and check whether ECMO is suitable. We will discuss the patient’s condition with relatives and we may ask about their medical history.

What are the potential risks of ECMO?

The main risk is bleeding. This is because the patient’s blood is made ‘thinner’ by the action of the ECMO machine, and also because a blood-thinning medicine called heparin is given to reduce the chances of blood clotting in the ECMO machine. Minor bleeding is common, and although this may look unsightly, this is not usually a major concern. More serious bleeding occurs in about 1 in 10 patients. If bleeding occurs into the brain, this may be fatal. We closely monitor blood tests every few hours to reduce the risk of serious bleeding problems. There is a small risk of damage to the heart or blood vessels when tubes are inserted into veins or arteries. We reduce this risk by using ultrasound and X-ray monitoring to guide us and supplying blood to the leg below where the tubes are inserted into arteries.

If ECMO is started, patients usually require ECMO for between five and fourteen days. Sometimes lung ECMO will be needed for several weeks. The patient will be cared for in an intensive care unit during this time. 

Around three in four patients who require ECMO for severe lung failure survive to be discharged from hospital. Only about half of people who require ECMO for severe heart failure survive to be discharged. Survival and recovery rates from ECMO at Barts Health are comparable to other centres nationally and internationally. We work closely with colleagues at other national ECMO services to maintain and improve our services and optimise patient centred outcomes.

Why is ECMO not available in all hospitals?

The number of people who need ECMO is low. ECMO needs specially trained staff and specialist equipment, so it is only available in a few hospitals in the UK. St Bartholomew’s Hospital is one of these hospitals. Patients who need ECMO are very ill and must be looked after on a specialist intensive care unit with medical, nursing, perfusion and allied health professional expert in the technology.

We support patients and families after they have gone home through our critical care follow-up service. The weekly clinic is staffed by consultants, senior nurses, with input from occupational therapists, physiotherapists and clinical psychologists.

We will address any ongoing needs following discharge from ICU and hospital and answer any questions about the time spent on ECMO and in intensive care. 

We will contact patients after discharge from hospital to arrange follow-up, but we welcome contact from healthcare professionals and patients who have received ECMO at St Bartholomew's Hospital. The follow-up service can be contacted by email.

• Clinical lead: Dr Sachin Shah
• Lead nurse: Debra Gaffey
• Matron: Moriom Bibi
• Lead perfusionist: Ayesha Khan
• Research lead: Professor Mark Griffiths

We run training courses throughout the year and these are open to external candidates from all healthcare backgrounds.

Our one-day course introduces people to ECMO.

Two-day courses are aimed at healthcare staff who will take significant roles in the day to day care of patients and include simulation scenarios to cover the main aspects of ECMO management.

For more information, please contact us by email.

We enjoy hosting visitors who wish to observe the work we do. Please email us if you would like to apply for a placement.

What is a registry? 

A registry record information about the health status and the treatments they receive. Clinical data registries typically focus on patients who share a common reason for needing healthcare. 

How do registries help patients? 

There are several registries that record details about patients who severe heart or lung failure including those supported with Extracorporeal Membrane Oxygenation (ECMO). Registries are used to provide information and evidence to:

• help doctors choose the best equipment for patients
• help understand which patients benefit from ECMO or other treatments and monitoring we provide
• help reduce the complications
• give regular feedback to hospitals, doctors and manufacturers about their performance

What information is collected? 

We send details about patients’:

• medical condition(s)
• treatments and monitoring including ECMO and which equipment was used
• procedures that were performed whilst in hospital
• length of stay in intensive care and in hospital  
• complications that occurred whilst in hospital 

We also send details of the patients’ age, dates of birth and gender. We do not send the patients’ names, addresses, postcodes or NHS numbers. 

Is the information safe? 

We currently send your data to registries in the UK, Europe and North America. All information is stored securely and anonymously on secure servers. This means it is very difficult to identify individuals. The use of patient data to support registries has been approved by the Caldicott Guardian at Barts Health NHS Trust. They are the person who is responsible for ensuring that all patient data are safe.

What information does the registry provide for patients? 

The registries do not give out specific information to patients or members of the public. It is designed to help healthcare professionals learn more about patients with severe heart or lung failure requiring intensive care.

Who can use the data in the registry? 

Data in the registry can be used for medical research. The purpose of this research is to improve our understanding about patients with severe lung or heart failure. All requests to use the data must be approved by the relevant registry committee. The committee checks that the requests have ethical approval and that the data will remain safe. Any data shared will be the minimum amount possible and anonymised. They will not know which hospital submitted the information.