Training and QA for your regional unit

·18 min·1 clip

Matt Brain describes running an ECMO service from a small regional ICU in Tasmania, challenging the norm of high-volume centers.

The episode is a recorded conference presentation by intensivist Matt Brain at the College of Intensive Care Medicine's 2018 annual scientific meeting in Hobart. Brain, from Launceston General Hospital in Tasmania, discusses his experience running a regional ECMO service since 2013. He begins by contextualizing the ICU as a 464-bed hospital with 11 ICU beds, serving as a referral center for northern Tasmania but lacking cardiothoracic and neurosurgical services. The service originated from available equipment purchased during the 2009 swine flu pandemic and was spurred by Brain's personal frustration as a registrar when a young patient died despite unused ECMO kits. After fellowship training at the Alfred Hospital in Melbourne during the CHEERS study on ECMO CPR, Brain helped launch the Launceston service. Key elements include developing policies and guidelines, training staff (24 nurses can run ECMO, 6 can prime circuits), and maintaining a core consultant group. The service operates as a satellite with backup from the Alfred, emphasizing careful patient selection and consultation for complex cases, especially VA ECMO. Brain presents data: 21 patients over 90 ECMO days, with 55% overall survival, 64% for VV ECMO, and 33% for VA ECMO. Eight patients were transferred to Melbourne on ECMO. He highlights the unexpected benefit of an automated CPR device, which he argues may have helped more patients than ECMO itself by enabling angio lab procedures under compressions. Challenges include high staff utilization, emotional investment in a small unit, and managing complications like HITs or aortic dissections. The presentation concludes by reiterating the service's role in providing timely local care and acting as an emergency bridge, while acknowledging its small scale and reliance on external support.

As heard by us

A practical regional ECMO review focused on readiness, team discipline, emergency coordination, and the measured use of mechanical CPR.

Regional ECMO is framed here as a test of preparation under pressure, with Matt Brain describing how a small ICU in Launceston has shaped its service since 2013.

Read the full review in PlayNext →

Why you'd press play

You want to know what regional ECMO demands once the circuit is primed and the small ICU has to make the service work.

Read the full recommendation in PlayNext →

Listen to the show on

Apple Podcasts Spotify

Play clips from this episode More from Neuro Resus