Mapping transitional care models after ICU discharge for ECMO survivors: A scoping review

Abstract

Introduction

ECMO survivors frequently develop post-intensive-care syndrome (PICS) with cognitive, psychological, and functional sequelae. Transitional care seeks to bridge ICU discharge and community recovery but remains variably structured, timed, and evaluated.

Objectives and methodology

To map transitional care models for ECMO survivors after ICU discharge, describing what is implemented, when (timing), and which outcomes are measured. Scoping review (JBI), reported per PRISMA-ScR. Databases: MEDLINE/PubMed, B-On, Web of Science (January 2015–June 2025). Grey literature: Google Scholar, OpenGrey, ELSO, OSF, ClinicalTrials.gov. Keywords and MeSH terms used: Extracorporeal Membrane Oxygenation [MeSH], Aftercare [MeSH], post-intensive care syndrome [MeSH], Critical Care [MeSH], Transitional Care [MeSH]. Eligibility: adults (≥18) on VV/VA ECMO with post-ICU data; excluded intra-operative ECMO < 24 h and studies without extractable ECMO-specific outcomes.

Results

Search retrieved 4101 studies, screening identified 740 records; 41 were included; 699 were excluded (duplicates; non-ECMO or intra-operative ECMO; no transitional intervention; no ECMO-specific outcomes). Seven domains were identified: structured follow-up pathways (n = 12); multidisciplinary interventions (n = 10); psychological/PICS support (n = 7); functional rehabilitation (n = 6); educational/organizational training (n = 5); telemonitoring/digital follow-up (n = 3); palliative/survivorship models (n = 2). Follow-up timings: pre-discharge; ∼1 month; 3–6 months; ≥12 months. Common outcomes: HRQoL, functional status (e.g., 6MWT/ADL), return to work, psychological symptoms (e.g., anxiety/depression/PTSD), readmissions/complications. Designs were predominantly observational/qualitative; trials with comparators were infrequent.

Discussion

Emerging concepts—ECMO survivorship, digital follow-up pathways—are not yet indexed in MeSH. Heterogeneity in structures, timing, and instruments limits comparability. Limitations include reliance on descriptive designs, variable reporting, and potential overlap across reviews.

Conclusions

This scoping review identified seven domains of transitional care for ECMO survivors after ICU discharge. However, the implementation of these domains and the outcome measures used to evaluate them were heterogeneous and inconsistently reported across studies, highlighting the need for more robust, outcome-focused research.