Coordination of care

While Australia enjoys well established coordinated care for patients on mechanical ventilation, there are important gaps remaining in specific areas of critical care, in particular the use of ECMO and VADs.

A recent CRE-ICU study identified four major barriers to safe ECMO delivery: inexperienced staff with a lack of training, inconsistent guidelines, poor reporting of complications and poor communication between ECMO ICUs. (Fulcher et al, Int Care Med 2020)

Our coordination of care program aims to advance new knowledge about when and how we should use ECMO and VADs to greatest effect.

Examples of our work include:

  • Optimise and standardise patient, device and site selection when the heart is failing

    We’re scaling up our existing EXCEL registry, a partnership with the Heart Foundation, to cover ALL Australian ECMO ICUs, and capture outcomes for high vs low volume centres, rural vs metropolitan centres, patient retrieval on ECMO, and mechanical circulatory support devices such as VADs.

  • Evaluate ECMO costs at site, state and national levels

    We’re harnessing data from the national ECMO registry and EXCEL registry, hospitals and other datasets to better understand cost-effectiveness, and provide reports to relevant stakeholders.

  • Test the feasibility of delivering ECMO in the community for cardiac arrest

    In partnership with Ambulance Victoria and Alfred Health, we’re undertaking a pilot program to improve out-of-hospital cardiac arrest survivorship by training specialist clinicians to deliver ECMO-CPR. If feasible and effective, we plan to scale up nationally to transform care.

  • Evidence synthesis and guideline development

    We’re working with end-users, including consumers, to create or update clinical guidelines around mechanical ventilation, ECMO in acute heart failure, ECMO-CPR in cardiac arrest, and early rehabilitation in invasive life support.

  • Standardise training and competency

    With our clinical partners, including the Australian College of Intensive Care Medicine (CICM), we will develop and implement an ECMO national training strategy and certification program.