title: Development of the first adult respiratory extracorporeal membrane oxygenation center in Croatia under emergency circumstances.
abstract: We report on the challenges of establishing a successful adult respiratory extracorporeal membrane oxygenation (ECMO) center in a developing country like Croatia under emergency conditions. We further introduce measures that would improve the outcome of patients treated with ECMO for respiratory failure at the national level.
  
  
  
  100 consecutive adult patients treated with venovenous (VV) ECMO for acute respiratory failure were enrolled to the database prospectively from October 2009 until June 2016. A review of methodology in establishing an adult respiratory ECMO center is provided.
  
  
  
  7 years after the establishment of the first respiratory ECMO center in Croatia the hospital mortality was 44% and ECMO procedure survival was 71%. With this data, our results are comparable to an average extracorporeal life support organization (ELSO) center.
  
  
  
  Our results demonstrate that a successful adult respiratory ECMO center can be established under emergency conditions even in less developed countries like Croatia. Today Croatia's respiratory ECMO network is insufficiently organized and the Ministry of Health should provide a comprehensive, national, ECMO network strategy. Currently, and contrary to the opinion of the world's leading experts, any hospital in Croatia is allowed to perform the ECMO procedure without any control or validation. Only if health-policy makers in Croatia reconsider this issue will we be able to provide the best care possible for respiratory ECMO patients at the national level.
authors.affiliation: Department of Intensive Care Medicine and Neuroinfectology, University of Zagreb School of Medicine, Dr. Fran Mihaljević University Hospital for Infectious Diseases, Zagreb - Croatia.
authors.forename: Marko
authors.initials: M
authors.lastname: Kutleša
authors.affiliation: Department of Intensive Care Medicine and Neuroinfectology, University of Zagreb School of Medicine, Dr. Fran Mihaljević University Hospital for Infectious Diseases, Zagreb - Croatia.
authors.forename: Bruno
authors.initials: B
authors.lastname: Baršić
mesh_terms: D000328:Adult; D017523:Croatia; D003906:Developing Countries; D004632:Emergency Medical Services; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D015397:Program Evaluation; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*