Family Members' Recollections of the Care of ECMO Patients Transferred From a Spoke Hospital to a Hub Hospital: A Qualitative Study.

Background: Patients with severe hypoxaemia due to Adult Respiratory Distress Syndrome may require extracorporeal membrane oxygenation (ECMO). ECMO centres, known as 'hub hospitals', provide mobile teams that can initiate ECMO treatment at local 'spoke' hospitals before transferring patients to hub facilities. This hub-and-spoke system is operational throughout northern Italy.

Aim: To explore the experiences and perceptions of family members when their loved ones received ECMO treatment and were subsequently relocated from a spoke hospital to a hub hospital.

Study design: Semi-structured phone interviews with thematic analysis. Family members of patients transferred with ECMO from a spoke to a hub hospital were recruited for this study. Data analysis followed the principles of thematic synthesis.

Results: Six phone interviews were conducted with family members eligible for the study. Three main themes and nine subthemes were generated from interview data: (1) The 'Wait' (subthemes: Fear, despair and anguish; Disbelief; Confusion and disorientation; Daily clinical news), (2) The 'Trust' (Trust in healthcare professionals; Hope and optimism; Technology), and (3) The 'Gratitude' (Fortune and awareness; Commitment, humanity and to take care of). Each relative's experience was unique; however, several common behaviours and emotional patterns emerged during the interviews. The ECMO process was perceived as a collaborative experience involving the interplay between patients, their family members and healthcare providers.

Conclusions: Family members' experience with ECMO patients indicates that ECMO is perceived as a crisis-focused intervention that provides last-minute hope. Despite the dire circumstances, the narratives shared by the interviewees provided the ability to reflect on their ICU experiences.

Relevance to clinical practice: The findings of this small, single-location study indicate that including the viewpoints of patients' families in future qualitative research and follow-up initiatives for former ICU patients could provide further understanding of how family members perceive the experience of a patient undergoing ECMO. The involvement of family members is crucial when providing care to critically ill patients. This is particularly relevant for critical care nurses who play a key role in supporting families during ECMO.