Abstract

Background: Adult Extracorporeal Membrane Oxygenation (ECMO) in the UK is delivered by an eight-centre network (1) with their catchment areas based on population density. The primary method for referral to ECMO by hospitals in the UK is through an online portal – Refer-a-Patient (2). 

Methods: A retrospective, descriptive study of monthly ECMO referrals using two sources: Refer-a-Patient; (03/2020–06/2025) and Royal Brompton Hospital (RBH) ECMO commissioning data; (04/2019–06/2025). Volumes, temporal trend, seasonality using STL (Seasonal-Trend decomposition using LOESS) and geospatial flows to RBH were analysed using Python. 

Results: Network referrals surged during COVID-19 waves, then settled to a lower baseline with recurrent winter peaks. Excluding 2020–2021, STL showed moderate–strong seasonality (seasonality strength = 0.64; seasonal signal-to-noise ratio = 3.29) and a modest increasing trend since 2022. In RBH (n = 2,831 referrals; January 2019 - June 2025), only 16.1% proceeded to ECMO; 108 patients were transferred but not cannulated. Geospatially, flows were clustered locally around London, with fewer long-distance referrals and some cross-catchment movements.

Conclusions: ECMO referrals in the UK showed seasonality, two main decision-making stages post-referral, and higher volumes of referrals to RBH from local hospitals. Cross-catchment flows were also observed. 

References:

1. Signpost [Internet]. [cited 2025 Sep 24]. Signpost | ECMO | Highly Specialised Services. Available from: https://www.signpost.healthcare/ecmo-referral-pathway
2. Referapatient Homepage [Internet]. [cited 2025 Sep 26]. Available from: https://www.referapatient.org/refer-a-patient