Key result
Regional hub-and-spoke ECMO networks with early referral, mobile retrieval, and tele-ECMO provide a safer framework for resource-limited settings than standalone low-volume units.
Why the study?
ECMO access remains concentrated in experienced tertiary centres, while distance, limited critical-care infrastructure, workforce shortages, and high treatment costs delay assessment and transfer for patients in resource-limited and geographically remote settings.
How can extracorporeal membrane oxygenation (ECMO) access be safely, practically, and ethically developed for patients with refractory organ failure in resource-limited and geographically remote settings?
How can extracorporeal membrane oxygenation (ECMO) access be safely, practically, and ethically developed for patients with refractory organ failure in resource-limited and geographically remote settings?
Expanding ECMO access to underserved and resource-limited regions should prioritize regional hub-and-spoke networks, safe retrieval, and strict clinical governance rather than the unsupported proliferation of standalone low-volume centers.
Answers are grounded in this paper and cite their sources.
Supports regional hub-and-spoke ECMO networks in resource-limited settings; leaves open prospective validation before practice change.
Extracorporeal membrane oxygenation (ECMO) can provide temporary respiratory or circulatory support for selected patients with otherwise refractory organ failure. Access, however, remains concentrated in experienced tertiary centres. Distance, limited critical-care infrastructure, workforce shortages and high treatment costs can delay assessment and transfer for patients living outside major urban areas. This narrative review examines practical and ethical approaches to developing ECMO access in resource-limited and geographically remote settings, with emphasis on regional coordination rather than indiscriminate expansion of stand-alone services. The manuscript synthesizes selected clinical trials, professional guidance, registry-based literature and implementation-focused publications relevant to ECMO selection, service organisation, transport, training, safety and affordability. It is a narrative review and should not be interpreted as a systematic review. A hub-and-spoke pathway can support early recognition and consultation at peripheralhospitals while concentrating complex cannulation, management and rescue capability in experienced centres. Mobile retrieval and tele-ECMO may extend access, but require trained teams, reliable transport systems, clear governance and predefined escalation pathways. Cost estimates and claims of large savings are highly context-dependent and should not be generalised without local economic evaluation. Patient selection, informed consent, transparent resource allocation, adverse-event review and prospective outcome reporting are essential. ECMO access beyond major cities is most defensible when built around regional networks, timely referral, competent multidisciplinary teams and auditable outcomes. The priority should be to strengthen safe pathways to established expertise; a local ECMO service should be introduced only when minimum clinical, logistical and financial safeguards can besustained.
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Lopa et al. (2026) conducted a review in Refractory respiratory or circulatory organ failure in resource-limited and geographically remote settings. Extracorporeal membrane oxygenation (ECMO) delivered via regional hub-and-spoke networks, mobile retrieval, and tele-ECMO vs. Indiscriminate expansion of stand-alone local ECMO services or conventional management without regionalized pathways was evaluated. Regional hub-and-spoke ECMO networks with early referral, mobile retrieval, and tele-ECMO provide a safer framework for resource-limited settings than standalone low-volume units.
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