ECMO is the oxygenation of blood by an artificial, modified heart-lung machine. Two large cannulas are inserted to allow the blood to circulate extracorporeally. Cannulation takes approximately 60 minutes and is performed in the intensive care unit or in theatre under TTE or TOE guidance. After successful cannulation and stabilisation of the patient on ECMO, the patient is transported back to RPAH or SVH.
- RPAH ECMO Retrieval Preparation Checklist for Referring Hospitals
Use this checklist to prepare your patient for ECMO Retrieval:
We request that the following preparations be made:
- Verify that the patient is as stable as possible.
- Ensure all medical records, imaging studies, and lab results are complete.
- Confirm that all monitoring and life-support equipment is operational.
- Communicate essential patient details with the retrieval team.
- Follow established stabilization protocols before transfer.
1. Patient Preparation
Family Notification:
- Inform the patient’s family about the ECMO retrieval process and, whenever possible, have them available to discuss consent.
Arterial Line Insertion:
- Insert a RIGHT radial arterial line if ECMO is required for cardiac support.
Pregnancy Testing:
- Perform a pregnancy test for all women aged 12–60 years.
Central Line Management:
- Leave the current central line in place as it may be required for ECMO cannulation.
- If the right internal jugular vein (IJV) or femoral vein is occupied, insert a 4-lumen central venous catheter (CVC) into the LEFT IJV and transfer all ongoing infusions accordingly.
IV Access:
- Attach a pump set (with crystalloid solution) to any large-bore intravenous access.
Documentation:
- Ensure all notes and charts are photocopied.
- Make sure all imaging studies are available on CD or have been transferred electronically to the ECMO retrieval centre.
2. Organize the ICU or Operating Theatre
Bed Space Requirements:
- Prepare a large ICU bed space that can accommodate surgical trolleys, a TOE (transoesophageal echocardiography) machine, and a vascular ultrasound machine.
Mandatory Equipment:
- Vascular Ultrasound Machine: Essential for guiding cannulation.
- TTE probe and TOE Probe and Ultrasound Machine: Required for imaging guidance during cannulation.
Surgical Setup:
- Provide two large, empty surgical trolleys with drapes to establish a sterile field for cannulation.
- Arrange one small, empty trolley to hold the ECMO pump.
3. Current Investigations
Laboratory Tests:
- Full Blood Count (FBC)
- Electrolytes
- Creatinine
- Liver Function Tests (LFTs)
- Lactate
- C-reactive Protein (CRP)
- Coagulation Profile: APTT, INR, fibrinogen, D-dimer, and LDH
Imaging and Diagnostics
- Chest X-ray
- Electrocardiogram (ECG)
- Echocardiogram (if available)
- Review of current microbiology results
4. Blood Bank Requirements
Group and Hold:
- Ensure that a valid group and hold is in place.
Crossmatch Requirements
- Packed Red Cells: Crossmatch 2 units if the hemoglobin is < 100.
- Platelets: Crossmatch if the platelet count is < 100.
- Fresh Frozen Plasma (FFP):: Crossmatch 2 units if the INR is > 1.5 or the APTT is > 60.
Use this referral process for ECLS referrals to the NSW ECLS Retrieval Service.
Click here for downloadable pdf: NSW ECLS Referral process
