Zhang J, Nagamine T, Vu K, Ali M, Limpruttidham N, Gozun M, Moreno JP, Banerjee D. Comparison of a direct vs consultative advanced heart failure role in the outcomes of extracorporeal membrane oxygenation patients. World J Transplant 2025; 15(3): 102078 [DOI: 10.5500/wjt.v15.i3.102078]
Corresponding Author of This Article
Dipanjan Banerjee, MD, MS, Professor, Department of Medicine, The John A Burns School of Medicine, University of Hawai'i, 651 Ilalo St, Honolulu, HI 96813, United States. dipanjan@hawaii.edu
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Sep 18, 2025; 15(3): 102078 Published online Sep 18, 2025. doi: 10.5500/wjt.v15.i3.102078
Comparison of a direct vs consultative advanced heart failure role in the outcomes of extracorporeal membrane oxygenation patients
James Zhang, Todd Nagamine, Kimberly Vu, Mohammed Ali, Nath Limpruttidham, Maan Gozun, Jesus Pino Moreno, Dipanjan Banerjee
James Zhang, Department of Cardiovascular Medicine, University of Washington, Seattle, WA 98195, United States
Todd Nagamine, Kimberly Vu, Mohammed Ali, Nath Limpruttidham, Maan Gozun, Jesus Pino Moreno, Dipanjan Banerjee, Department of Medicine, The John A Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, United States
Author contributions: Banerjee D and Zhang J formulated the research question; Vu K, Gozun M, Nagamine T, and Ali M performed data collection and initial manuscript drafting; Limpruttidham N and Banerjee D provided statistical analysis; Moreno JP helped revise the manuscript; Banerjee D was responsible for the final draft of the manuscript.
Institutional review board statement: This study was approved by the Queen's Medical Center Institutional Review Board.
Informed consent statement: Informed consent was waived for this study by the Queen's IRB given its retrospective nature.
Conflict-of-interest statement: There are no conflicts of interest to report for any of the authors involved in this manuscript.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement:sharing statement: We are happy to share deidentified data for those who request it.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dipanjan Banerjee, MD, MS, Professor, Department of Medicine, The John A Burns School of Medicine, University of Hawai'i, 651 Ilalo St, Honolulu, HI 96813, United States. dipanjan@hawaii.edu
Received: October 8, 2024 Revised: February 26, 2025 Accepted: March 18, 2025 Published online: September 18, 2025 Processing time: 192 Days and 7.9 Hours
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.
Core Tip: Patients receiving extracorporeal membrane oxygenation (ECMO) support are critically ill, and suffer from high morbidity and mortality. Advanced heart failure and transplant cardiology physicians have been shown to improve outcomes in patients suffering from severe cardiovascular disease. We found that at our center, advanced heart failure and transplant cardiology physicians improved post hospital discharge survival in patients receiving ECMO support when serving as the primary ECMO attending instead of in a consultative role. This was largely due to improved outcomes in patients receiving veno-arterial ECMO support.
