UK ECMO Network Service Evaluation - no ECMO

• Research type

  Research Study

• Full title

  Evaluating the Outcomes of Patients Referred for ECMO but Not Treated: A Retrospective Database Study

• IRAS ID

  357765

• Contact name

  Robert Gatherer

• Contact email

  robert.gatherer@nhs.net

• Sponsor organisation

  Royal Papworth Hospital

• Duration of Study in the UK

  0 years, 6 months, 2 days

• Research summary

  Introduction:

  Veno-venous extracorporeal membrane oxygenation (ECMO) is a critical intervention for patients with severe respiratory failure. Despite its potential benefits, not all patients referred for ECMO receive the treatment due to various clinical considerations. Few studies describe the outcome of these patients. Understanding the characteristics and outcomes of this No-ECMO cohort is essential for improving clinical decision-making, patient selection and care. Internationally and in the United Kingdom these factors are generally unreported and thus poorly understood.

  Objectives:

  • Identify the demographic and clinical characteristics of patients referred for ECMO but not treated.
  • Analyse the reasons for not initiating ECMO in these patients (too well, not yet eligible for ECMO but potential candidate, and no to ECMO for futility).
  • Evaluate the overall mortality outcomes of patients who were referred but did not receive ECMO.
  • Compare the overall mortality of the No-ECMO group with those patients who received ECMO.
  • Perform time-to-survival analysis between groups to assess overall survival difference.
  • Understand and identify potential areas for improvement in referral and treatment processes by characterising the whole severe respiratory failure cohort and not only those placed on ECMO

  Study Design:
  A retrospective descriptive cohort study examining UK ECMO network referral data.

  Data Sources:
  All commissioned adult UK ECMO centres collect key performance indicators (Numbers 101-106, 110-111, 113-115) as part of the service specifications stipulated by NHS England. These data are collected along with demographic and physiological variables at the time of referral via the national online platform Refer-a-patient (Bloomsbury Health, London).

  Inclusion Criteria:
  • The national ECMO eligibility criteria for the United Kingdom have been described in the literature and take into account NHS England service specifications (https://www.england.nhs.uk/wp-content/uploads/2019/02/Adult-ECMO-Service-Specification.pdf )2.
  • All adult patients ≥18 years of age referred for veno-venous ECMO for severe respiratory failure

  Exclusion Criteria:
  • Paediatric patients <18 years old
  • Patients referred for veno-arterial ECMO
  • Patients referred for bridge-to-lung transplant

  Data Collection:
  • Demographic details
  • Clinical indications
  • Severity scores (e.g. RESP score)
  • Physiological and ventilation data at the time of referral
  • Comorbidities, reasons for not receiving ECMO
  • Hospital admission to ECMO referral
  • Intubation to ECMO referral
  • Pre-ECMO therapies
  • Mortality status

  Statistical Analysis:
  Descriptive statistics will summarize patient characteristics. Time-to-event analysis will assess for overall survival differences between patient cohorts. Cumulative event rate plots will illustrate survival differences within the No ECMO cohort (too well, not yet eligible for ECMO but potential candidate, and no to ECMO for futility). Calibration of the RESP score will be assessed.

• REC name

  South Central - Hampshire A Research Ethics Committee

• REC reference

  25/SC/0363

• Date of REC Opinion

  19 Dec 2025

• REC opinion

  Further Information Favourable Opinion