ELSO ECMOed Survey Participation Form
The Extracorporeal Life Support Organisation (ELSO) is an international non-profit consortium of health care institutions dedicated to improving extracorporeal life support through continuing education, guidelines development, research, and maintenance of a comprehensive registry of patient data. The ECMOed Taskforce is working on a collaborative approach toward standardisation of global ECMO education. Please complete this form if your centre is interested in helping with this initiative and helping outline the current state of ECMO education worldwide.
Which country do you work in? *
Which city is your institution located? *
Your answer
What is your institutions name? *
Your answer
Do you provide ECMO in your institution? *
Is your institution an ELSO member? *
Would your institution be interested in participating in a larger ELSO ECMOed survey to assess the need for standardisation of ECMO education? *
Who is the best contact person in your institution for the larger ECMOed survey?
Please provide email address of the best contact person for the larger ECMOed survey
Your answer
(Optional)Please provide email addresses of other ECMO clinicians from your institution who may be interested in future ELSO surveys and ELSO newsletters
Your answer
Thank you for taking the time to complete this survey. We truly value the information you have provided to help advancement of extracorporeal life support throughout the world.
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