The effects of the introduction of an adult ECMO program on statewide referral patterns, casemix and outcomes in patients with acute respiratory distress syndrome or pneumonia

Dear Editor, extracorporeal membrane oxygenation (ECMO) use in adults is increasing and indications are expanding. The effects of introduction of an adult ECMO service on casemix, referral patterns and outcomes of patients with acute respiratory distress syndrome (ARDS) or pneumonia at a population level have not been well studied. Two hospitals commenced adult ECMO services in the Australian state of Queensland (area of 1,727,000 km2; population 4,729,000) in 2009 after the publication of the CESAR trial in preparation for the H1N1 influenza pandemic. ECMO was implemented as part of a statewide strategy for advanced support of respiratory failure by the intensive care clinical network. Prior to this there was no adult ECMO service.