J Extra Corpor Technol 2025, 57, 181--183 Ó The Author( s), published by EDP Sciences, 2025 https:// doi. org / 10.1051 / ject / 2025032
Available online at: ject. edpsciences. org
LETTER TO THE EDITOR
Building better ECMO rooms: a roadmap to standardization and innovation
Nada A. Aljassim( MD, FCCP) 1,*, Salman Abdulaziz( MBBS, FRCP) 2, and John F Fraser( MB ChB, PhD, FRCP( Glas), FFARCSI, FRCA, FCICM, FELSO) 3, 4
1 Consultant, Pediatric Critical Care Department, ECMO serviceline Lead, Critical Care Services Administration, King Fahad Medical City, Riyadh, Saudi Arabia 2 Consultant, Cardiovascular Critical Care, Critical Care Services Administration, King Fahad Medical City, Riyadh, Saudi Arabia 3 Critical Care Research Group Director, University of Queensland & AICS The Prince Charles Hospital, Brisbane, Australia 4 Director of Intensive Care Unit, St Andrew’ s War Memorial Hospital, 457 Wickham Terrace, Spring Hill, Qld 4000, Australia
Received 17 April 2025, Accepted 17 June 2025
Abbreviations
ECMO ICU
Extracorporeal membrane oxygenation Intensive care unit
Extracorporeal membrane oxygenation( ECMO) is increasingly recognized as a critical intervention for patients with refractory severe cardiac and / or respiratory failure who do not respond to conventional therapies. ECMO is a high-risk and demanding service that requires a trained multidisciplinary team that can provide close monitoring, and precise, thorough, and constant management. Timely intervention is essential in emergencies; any failure to address them when ECMO malfunctions or when a patient deteriorates can lead to life-threatening situations that impact the medical team and can lead to moral distress.
As ECMO use rises globally across all age groups, the need for optimized ICU rooms for ECMO patients-- complete with appropriate bed preparation, staffing, and resource allocation-- is vital. Such standardization can streamline ICU workflows and enhance patient safety and care quality. Although organizations like the Joint Commission International( JCI) and various critical care societies provide some guidelines for standard ICU setups, there is considerable variability in ICU infrastructure, room layouts, and best practices across different institutions. The set up often relies more on hospital infrastructure, and institutional experience than on established evidence. Furthermore, there are currently no specific evidence-based guidelines for the optimal design of ECMO rooms within ICUs, nor are there studies examining the various setups for running ECMO services and their impact on patient outcomes [ 1--3 ]. ICUs with an ECMO specialist model or a perfusionist at the bedside model may have different setups and requirements. Generally, there is no census of where ECMO rooms are located within
* Corresponding author: aljassim. nada4 @ gmail. com the ICU or as an ECMO unit in the hospital, but immediate access by the various specialists and caregivers should be guaranteed. It was shown that being within the ICU in a tertiary center is feasible and safe [ 4, 5 ].
We summarize the current knowledge on ECMO room preparation, highlight best practices, and propose suggestions that are summarized in Table 1 and shown in Figure 1, for further optimization and potential standardization with future research.
ECMO rooms considerations Physical space and infrastructure
An optimal ECMO room setup requires careful consideration of ICU layout, space allocation, staff-to-patient ratio, and access to essential equipment for safe and effective care. The literature suggests that a clearance of about 150 cm around the bed should be available, but does not specify the patient type of acuity and the number of machines required [ 6 ]. We suggest that patients on ECMO should have more than 25 m of sequence space and at least 150--200 cm of clearance around the bed. In ICUs with few ECMO cases, the ECMO room should be strategically located in a visible area, such as in front of the nurse’ s station. In ICUs with many patients on ECMO, all patients should be easily visible to the medical staff. If there are ECMO rooms for patients in isolation, these rooms should preferably have glass doors and be located near an on-call team, including physicians and perfusionists. ECMO rooms, like other ICU rooms, should have minimal interference with noise levels and optimal lighting, which can negatively impact both patients and caregivers [ 7--9 ]. The narrative review by Tronstad et al. investigated whether current ICU bed space designs are based on evidence and supportive of patient sleep. The authors found a significant gap between the recommended practices for
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