Prehospital ECMO in New South Wales: Lessons for BC

Extracorporeal membrane oxygenation (ECMO) is one of the most advanced life-support interventions available today. While its use in the prehospital setting has generated global interest, success of its implementation  has varied depending on how systems are designed. In the United States, where prehospital care is often limited to single-discipline paramedic models, attempts to deploy hospital-based ECMO teams in the field have faced major challenges.

By contrast, jurisdictions with established multi-disciplinary prehospital systems—such as New South Wales (NSW), London, Paris, and the Netherlands—have demonstrated far greater success implementing their programs. Their interprofessional physician–paramedic teams, already integrated and experienced in working together to deliver advanced critical care delivery outside hospital walls, provide a strong foundation for innovations like prehospital ECMO.

The recent NSW Health video, “PreCare: Prehospital ECMO,” highlights how Greater Sydney HEMS is pushing the boundaries of what’s possible in out-of-hospital resuscitation (watch here).

To date, most ECMO programs have been concentrated in urban centres. This risks widening the equity gap for rural and remote patients. Encouragingly, services in the UK, Scandinavia, and Australia are actively working to extend prehospital ECMO services into rural areas. BC must do the same if we are serious about equity and excellence. 

For British Columbia, the lesson is clear: the longer we delay building a multi-disciplinary prehospital care system, the further behind we will fall in bringing cutting-edge interventions like ECMO to our citizens. See also the post by Dr Jonathan Gravel about the cost-effectiveness of ECPR https://www.medresponsebc.ca/post/a-study-of-pre-hospital-ecpr-cost-effectiveness-in-new-south-wales