Adult venoarterial extracorporeal membranous oxygenation (VA ECMO) is a costly life-support therapy, where patient selection remains the significant hinge-point in determining patient outcomes. Despite this, few sites have formalized patient selection criteria, and even fewer have a robust multidisciplinary ECMO team to determine patient candidacy. Analyzing current literature revealed significant weaknesses in existing research on VA ECMO patient selection criteria, including the use of small sample sizes, lack of randomized controlled trials, lack of personalization of ECMO initiation decisions to patient pathology, and conducting studies on patients who received ECMO without including patient groups who were considered for ECMO but did not receive it. Among the available studies, the Survival After Venoarterial ECMO (SAVE) score has shown the greatest promise in selecting VA ECMO patients, excluding those undergoing extracorporeal cardiopulmonary resuscitation (ECPR) and postcardiotomy (PC) ECMO. The SAVE score has demonstrated good discrimination in non-ECPR and non-PC ECMO groups. Further research is needed on the predictive value of SAVE score risk classes and the discrimination of the SAVE score excluding PC ECMO and ECPR groups. The modified SAVE score, which includes lactate assessment in addition to SAVE score parameters, has shown the greatest promise in selecting ECPR and PC ECMO patients for VA ECMO. The modified SAVE score requires more external validation. Site-level research indicates that consultation with a multidisciplinary ECMO team, which collectively makes decisions about ECMO candidacy, has resulted in significantly improved patient survival outcomes compared to a one- or two-physician decision-making mechanism for VA ECMO initiation. Sites transitioning to an ECMO team approach should publish their patient outcomes before and after implementing the team approach.
A. Johal (Thu,) studied this question.