Comparison of a direct vs consultative advanced heart failure role in the outcomes of extracorporeal membrane oxygenation patients.

Abstract

Background: Advanced heart failure and transplant (AHFTC) teams are crucial in the management of patients in cardiogenic shock. We sought to explore the impact of AHFTC physicians on outcomes in patients receiving extracorporeal membrane oxygenation (ECMO) support.

Aim: To determine whether outcomes differ in the care of ECMO patients when AHFTC physicians serve in a primary vs consultative role.

Methods: We conducted a retrospective cohort study of 51 patients placed on veno-venous (VV) and veno-arterial (VA) ECMO between January 2015 and February 2023 at our institution. We compared ECMO outcomes between teams managed primarily by intensivists vs teams where AHFTC physicians played a direct role in ECMO management, including patient selection. Our primary outcome measure was survival to 30 days post hospital discharge.

Results: For combined VA and VV ECMO patients, survival to 30 days post discharge in the AHFTC cohort was significantly higher (67% vs 30%, P = 0.01), largely driven by a significantly increased 30-day post discharge survival in VA ECMO patients in the AHFTC group (64% vs 20%, P = 0.05).

Conclusion: This study suggests that patients in shock requiring VA ECMO support may have improved survival 30 days after hospital discharge when an AHFTC team serves in a direct role in the selection and management of patients. Further studies are needed to validate this impact.