Survey of adult extracorporeal membrane oxygenation (ECMO) practice and attitudes among Australian and New Zealand intensivists

To gauge use of extracorporeal membrane oxygenation (ECMO) in Australian and New Zealand intensive care units, to investigate attitudes to and experience with ECMO, and to assess interest in contributing to a national database of ECMO use.The survey was conducted by email in July 2004. A targeted cohort of ICUs across the two countries was chosen, comprising JFICM (Joint Faculty of Intensive Care Medicine) Approved Training Centres, and large regional and private institutions. Directors of the ICUs were invited to participate in the survey of department demographics, ECMO practice rates and experience, and attitudes to ECMO. The survey was registered (http://clinicaltrials.gov registration number NCT00157144), and local ethics approval was obtained.Response rate was 56% (39/70), with 49% of responses (19/39) from JFICM Approved Training Centres. ECMO practice in responding centres was low, with 69% (27/39) having managed no ECMO patients in the past year, and 62% (24/39) having managed none in the past 3 years. Only one centre had managed more than eight patients in the past year. Individual respondents had limited ECMO experience, with 56% (22/39) having ever managed two or fewer patients. The most common reasons given for not providing ECMO were lack of staff skill/training and lack of access to support services. Cost, high mortality and lack of evidence for ECMO efficacy were not regarded as significant factors preventing its use. Seventy-two per cent (28/39) of respondents supported ECMO use outside a randomised controlled trial, and 49% (19/39) would conduct ECMO at their own institution, while 74% (29/39) felt it a useful tool to facilitate transport to specialist centres.ECMO use in Australian and New Zealand ICUs is limited, but there is support for its use among survey respondents. Lack of training and experience with ECMO may be restricting its use.