In the light of literature data and our own experience (often painful), there are no longer any doubts that some percentage of patients with severe, fully reversible respiratory failure (in the course of pandemic influenza and many other disease) requires unconventional methods of oxygenation, including extracorporeal oxygenation. Moreover, it seems obvious that in some cases with a rapidly progressing illness, interhospital transport of patients on referral can be impossible; if ECMO cannot be administered in the referring hospital, the patient is bound to die.

The present issue of our journal contains the paper describing several cases of transportation of patients using extracorporeal membrane oxygenation (ECMO) [1]. Considering the findings reported we should decide what model of safety provision to patients with severe respiratory failure requiring above-standard techniques of oxygenation improvement (including ECMO) should be implemented in our country. Should one or several ECMO centres be organized (as in some other countries), or should the therapy be rather decentralized and involve all intensive therapy units in hospitals with cardiac surgery units? How to solve the problems related to transport of such patients throughout the country?

It is difficult to define what the cost and effectiveness of ‘ECMO centres’ working all year long would be. It is not known whether referrals of such patients (as our experience shows) would regard only short winter periods. In this situation, the concept of ‘ECMO centres’ is inevitably associated with an expensive skiing centre built in the region with good skiing conditions only during three months of the year.

Furthermore, centralization of ECMO therapy is quite risky and extremely burdening for intensive therapy units, which will accept the function of ‘ECMO centres’. Once the local community learnt that the intensive therapy unit in the Silesian Centre for Heart Diseases could provide extracorporeal oxygenation in extreme cases of respiratory failure, all patients requiring 100% oxygen ventilation were referred from all over the Silesian province during several months of influenza pandemic. Obviously, some patients did not meet the ECMO criteria or had evident contraindications for ECMO, yet whenever the admission was refused, we were fully aware what this might mean for a patient… In the short period, we received several referrals to ECMO therapy. In total, extracorporeal oxygenation was applied in 5 cases; during the most difficult period, the therapy was carried out simultaneously in three patients, which completely disorganised the normal functioning of our unit.

Generally, the formation of ‘ECMO centres’ may be a reasonable policy after all. The indications for extracorporeal oxygenation are much wider than AH1N1 influenza cases. Nobody knows how many patients with potentially reversible ARDS (not only in the course of influenza) die annually in Polish intensive therapy units due to hypoxaemia and what the dynamics and epidemiology of such deaths are. It appears that any binding decision about the future model of ECMO in Poland should be taken when such data are available. The register of patients hospitalized in Silesian intensive therapy units started in the autumn of the previous year on the initiative of professor Ewa Karpel, the Regional Consultant, may be of assistance.

All we know for the time being is that in mid March, ‘the ECMO alarm telephone’ stopped ringing and no new referrals were received until the present paper was submitted for publication. Has ‘the ECMO season’ vanished with the end of winter?

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adres/address:

*Piotr Knapik
Śląskie Centrum Chorób Serca
ul. M.Curie-Skłodowskiej 9, 41-800 Zabrze
tel./fax 32 273 27 31
e-mail: kardanest@sum.edu.pl

otrzymano/received: 25.04.2011
zaakceptowano/accepted: 20.07.2011