The process, logistics and governance behind a high-stakes novel intervention: the use of extracorporeal membrane oxygenation (ECMO) in the hyperbaric chamber.

Introduction: A multi-trauma patient receiving extracorporeal membrane oxygenation (ECMO) developed severe disseminated vaso-invasive fungal disease. In the absence of any remaining treatment escalation options, hyperbaric oxygen treatment (HBOT) was considered as a last effort at gaining disease control. Previously, the use of modern ECMO devices had not been validated for hyperbaric use at our centre or, to the best of our knowledge, at any other centre around the world. We had, however, identified a potentially hyperbaric compatible ECMO device and had commenced a validation process. The aim of this report is to highlight the practical, operational and governance processes undertaken to safely provide HBOT utilising ECMO at short notice. Methods: A detailed risk assessment, development of risk reduction strategies and workflows, emergency out-of-session ethics review, clinical innovations committee review, legal advice, executive approvals and informed consent were undertaken over a 32-hour period prior to commencing HBOT. Results: We present the identified risks, governance approvals, workflow, staffing model, chamber layout and safety checklist utilised to successfully deliver thirteen HBOT sessions to a patient on venovenous (VV) ECMO. Conclusions: Through an extensive and coordinated effort involving multiple specialties and disciplines at our service, we were able to safely deliver HBOT to a patient supported by VV ECMO.