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

role of this therapy in the adult population compared with best standard care is uncertain. It may be used for respiratory or cardiac support in patients with life-threatening cardiorespiratory failure. The largest database for ECMO outcomes is run by the Extracorporeal Life Support Organization, 2 which began in 1989. This registry records more than 30 000 cases, with an overall 66% survival. Adult ECMO patients make up 5% of this total. Past randomised controlled trials (RCTs) of ECMO in adult respiratory failure 3,4 demonstrated high mortality and no survival benefit compared with standard medical therapy. Currently, a trial of ECMO for adults with respiratory failure is underway in the United Kingdom — the CESAR trial (Conventional Ventilation or ECMO for Severe Adult Respiratory Failure; http://www.cesar-trial.org). This is the largest ECMO trial to date and powered to detect a mortality difference, as well as quality of life and economic outcomes. ECMO has been used for adults in Australia and New Zealand 5-12 with some success, but the extent and nature of its use in adults is unknown. The largest case series to date reported outcomes of 17 patients. 10 No regional standards for staffing, training and equipment exist for the long-term (days to weeks) application of this technology in the intensive care unit. Barriers to the implementation of ECMO in Australia and New Zealand are not known. This study aimed: • to gauge the use of ECMO in Australian and New Zealand intensive care departments over periods of 12 months and 3 years; • to sample the attitudes toward ECMO practice and barriers preventing its use; and • to assess interest in a prospective database of ECMO practice.