Supplementary file 1_ECMO in hinterland—feasibility and challenges (case-based narrative review).pdf

This review aims to fill that gap by directly comparing three practical models. Using case-based discussions and available literature, the review outlines the common foundational requirements for safe ECMO delivery, including infrastructure, logistics, multidisciplinary teamwork, transport preparedness, ethical governance, and protocol standardisation. It explores the advantages and disadvantages of each model, with a focus on components such as early referral, expert oversight, safe interfacility transfer, and a viable long-term partnership between peripheral and expert ECMO centres to improve patient outcomes.

The review discusses ethical and financial aspects of ECMO program. It specifically explores the future role of telemedicine, artificial intelligence, and digital connectivity in expanding ECMO across all areas. To conclude, the review demonstrates that, with proposed models of structured systems and appropriate training, ECMO can be safely extended to unexplored regions while maintaining quality and patient safety.</p>