PRACTICAL RECOMMENDATIONS FOR EXTRACORPOREAL MEMBRANE OXYGENATION IMPLEMENTATION IN MULTIDISCIPLINARY HOSPITALS: LESSONS LEARNED FROM FIVE-YEAR EXPERIENCE OF HEART CENTER SHYMKENT

Introduction. Extracorporeal membrane oxygenation (ECMO) has become an essential life-support modality for patients with severe cardiopulmonary failure. However, ECMO programs remain predominantly concentrated in highly specialized centers with cardiothoracic surgery services, limiting access to ECMO in many multidisciplinary hospitals. Objective. To develop practical recommendations for ECMO implementation in multidisciplinary hospitals without in-house cardiac surgery by integrating international evidence with the five-year institutional experience of the Heart Center Shymkent. Methods. This study combined a narrative review of international literature on ECMO program development with a retrospective observational analysis of ECMO utilization at the Heart Center Shymkent, between 2019 and 2024. Clinical indications, ECMO configurations, organizational aspects of program development, team structure, and patient outcomes were assessed, with particular attention to staged implementation and integration of ECMO into existing intensive care pathways. Results. Between January 2019 and December 2024, 91 ECMO procedures were performed in patients with severe cardiopulmonary failure refractory to conventional treatment. The major indications included cardiogenic shock, severe respiratory failure, extracorporeal cardiopulmonary resuscitation, and post-cardiotomy cardiac failure. During the COVID-19 pandemic in 2021, ECMO support was initiated in 12 pregnant and postpartum patients with severe respiratory failure; successful decannulation was achieved in 5 patients (42%). Over the study period, ECMO activity expanded in parallel with the development of multidisciplinary teams, protocol standardization, and structured workforce training. Conclusion. The experience of the Heart Center Shymkent suggests that a structured ECMO program can serve as a practical, reproducible model for multidisciplinary hospitals without in-house cardiac surgery. A staged implementation strategy based on restricted initial indications, multidisciplinary collaboration, protocolized care, and continuous quality monitoring may support safer and more sustainable expansion of extracorporeal life support in resource-constrained settings.