Association of Multidisciplinary Heart Failure Team with Outcomes in Patients Requiring Extracorporeal Membrane Oxygenation

Abstract

Purpose Veno-arterial (VA) ECMO plays a central role in patients with refractory cardiogenic shock. Whether involvement of a multidisciplinary heart failure team (HF-MDT) at time of VA-ECMO initiation would be associated with differences in downstream management and outcomes is unknown. Methods Patients who received VA-ECMO (12/16 to 09/20) at a quaternary care center in the Middle East were retrospectively identified. Patients were grouped according to HF- MDT involvement—defined as providing input on VA-ECMO initiation/ weaning in addition to active management of vasoactive medications. Baseline characteristics, subsequent management and clinical outcomes were compared between patient who received VA-ECMO with and without HF-MDT involvement. Results A total of 47 unique patients (median age 49 years, 78.7% males) were identified. Most common indications for ECMO initiation was post-cardiotomy (34%), followed by cardiogenic shock secondary to advanced heart failure (25.5%). HF-MDT was involved in ECMO initiation in 48.9% (23/47) patients. Patients where HF-MDT was involved were younger (41.1 ± 13.9 vs 57.9 ± 14.6; P Conclusion HF-MDT involvement in VA-ECMO initiation provides unique input on decision-making, including selection for advanced therapies and hemodynamics-directed use of vasoactive medications. Establishing multidisciplinary teams for cardiogenic shock management helps standardize treatment of this subset of complex patients. The impact of such teams on resource use and clinical outcomes needs to be evaluated in larger studies.