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Extracorporeal membraneous oxygenation (ECMO) is a form of life support used to replace the function of failing lungs. The first trial of ECMO occurred in 1970 in the USA which showed limited survival benefit. Since then ECMO technology and expertise has gradually increased, particularly in response to the 2009 swine flu pandemic.
The results of the UK CESAR Trial were published in 2010. This clinical research trial compared the use of ECMO to other methods of life support, and identified a sub group of patients with severe acute respiratory failure who were more likely to improve with ECMO support.
There are currently five critical care centres in commissioned by NHS England to provide ECMO for adults with severe acute respiratory failure. The five centres collaborate as a national network and they also provide services to Scotland, Wales and Northern Ireland. It is therefore not uncommon for patients to be transferred many miles from home in order to have access to such a highly specialised clinical service. Where patients transfer from one hospital to another it is important that critical clinical information is shared in a safe and timely manner.
The Hospital to Home pathway was originally developed for children on long term ventilation (LTV) to provide a structured process for hospital discharge and has been expanded to support LTV follow up and the process of weaning from respiratory support. The clinical pathway is hosted on a shared and secure central platform within the NHS environment. This means that a single care pathway can be viewed by appropriate healthcare professionals from any NHS environment, in both hospital and community care settings.
It was recognised that the principles of the LTV exemplar pathway, and the process of transfer between centres from hospital to home, could be applied to other clinical pathways, particularly where patients needed to be cared for across multiple organisations.Like the LTV population, patients who are referred for ECMO support are relatively rare, and medically very complex.
With support from NHS England Integrated Digital Care Fund and Royal Brompton ECMO team, we designed a pathway to facilitate information transfer around referral, rehabilitation and repatriation of patients with severe acute respiratory failure who are referred for consideration of ECMO. The development cycle for this new pathway began in March 2015 and the first patient was referred to the online pathway on 25 January 2016.
The Hospital to Home team are dedicated to delivering continuous improvement for patients and to share solutions across the NHS. New care pathways are currently in development and will be announced in due course. We are always willing to listen to ideas for new innovations where a combination of expert people, a shared platform, and a well designed clinical process can deliver benefit for patients and staff.