In the UK, the National Health Service England has commissioned 5 surgical centres on a regional basis to cover the whole country to provide ECMO support for adult respiratory failure. The RPH covers the eastern region of the UK and is one of the designated centres for ECMO. Each centre provides an around-the-clock retrieval service and under usual operating conditions is responsible for providing 3 ECMO beds. The current system was developed in response to the increasing number of the patients requiring ECMO support for respiratory failure, first seen in the H1N1 influenza pandemic of 2010 [4]. This provision can be increased further during surge conditions in response to winter influenza epidemics. During the COVID-19 pandemic, the number of beds at each centre increased to 20.