Evaluation and policy considerations in the introduction of extracorporeal membrane oxygenation

The introduction of extracorporeal membrane oxygenation (ECMO) in Australia was associated with establishment of the technology at two teaching hospitals followed by appraisal through a consensus conference and a subsequent synthesis report and cost analysis. The assessments and associated policy processes have helped to define the place of the technology, but many uncertainties remain due to limited relevance of results from other countries, the preliminary nature of local data and absence of controlled trials. This experience raises questions concerning approaches by professional groups, funding authorities and assessment agencies in dealing with specialised new techniques which are associated with a small national caseload.