Structure of an ECMO network for respiratory support

In adult patients with respiratory failure refractory to conventional treatment, ECMO represents a potentially lifesaving option, and the CESAR trial indeed indicated that significantly more patients with severe ARDS survived without severe disability if they were transferred to a single ECMO center compared with patients who were managed conventionally at remote hospitals. During the 2009 influenza A (H1N1) pandemic, the Italian Ministry of Health instituted a national network of selected ICU centers, the Extracorporeal Membrane Oxygenation Network (ECMOnet). The Italian network was set up to centralize all potentially severe patients in a limited number of tertiary hospitals to provide advanced treatment options including ECMO and identify predictors of mortality in order to define the best timing of ECMO institution. The institution of the Italian ECMO network allowed a high survival rate of patients with severe ARDS due to H1N1 infection treated by ECMO, providing effective and safe centralization and creating an important organization platform to face future possible epidemics with high demand for critical care services and specialized respiratory support.