Outcomes of patients receiving extracorporeal membrane oxygenation: Direct vs consultative advanced heart failure and transplant cardiology physicians’ role

Abstract

This manuscript provides a commentary on the article by Zhang et al. Patients with heart and pulmonary failure who do not respond to standard treatment may benefit from extracorporeal membrane oxygenation (ECMO) support. Advanced heart failure and transplant cardiology (AHFTC) teams play an essential role in managing patients in cardiogenic shock. To determine whether ECMO patient management outcomes differ based on whether AHFTC physicians assume a direct or consultative role, a retrospective cohort study of 51 patients placed on veno-venous and veno-arterial (VA) ECMO between January 2015 and February 2023 was conducted. Results demonstrated a significantly higher 30-day post-discharge survival rate in the AHFTC direct involvement cohort compared to the consultative group (67% vs 30%) for all ECMO patients. This survival benefit was primarily attributable to VA ECMO patients (64% vs 20%). Direct involvement of AHFTC teams in patient selection and management may enhance survival in patients requiring VA ECMO for cardiogenic shock; however, further research is necessary to confirm these findings.

Keywords: Advanced heart failure; Critical care; Extracorporeal membrane oxygenation; Mortality; Patients’ outcomes; Physicians’ role; Transplant cardiology; Veno-arterial; Veno-venous

Core Tip: Mortality and morbidity remain substantial among critically ill patients receiving extracorporeal membrane oxygenation (ECMO). Evidence shows that advanced heart failure and transplant cardiology specialists improve outcomes by assuming a direct attending role rather than a solely consultative role. This improvement is especially evident in patients receiving veno-arterial ECMO support.