Abstract Rationale What are the outcomes of MICU patients who had ECMO consultations but do not receive ECMO compared to those who are cannulated? When patients are declined for having either contraindications or not having indications (BenefitRisk), or are managed utilizing other non-invasive strategies (advanced MV modes, improved positioning and mobilization, optimized hemodynamics) how do the outcomes compare to those who received ECMO? Methods A retrospective review of all MICU patients who had ECMO consultation from 7/2017 to 6/2025 was performed using our ECLS Service registry to identify patients. The EMR was also used to gather additional data. Results 74 total patients were identified for ECMO evaluation (VV 60, VA 7, ECPR 7) with three having x2 consults. 12 patients received ECMO (10 VV and 2 VA) with 60% survival to hospital D/C; Dispositions were 33.3% home, 33.3% to another facility for transplant evaluation, 16.7% to LTAC and 16.7% to rehab. 17 patients (all VV consults) were managed by ECLS service w/o ECMO with 82.4% survival (all deaths in COVID-ARDS); Dispositions were 78.6% Home, 14.3% Rehab, 7.1% LTAC. 17.6% had tracheostomy performed ECLS consulted MV d13, 12 and 7 respectively but all decannulated prior to D/C. 31 patients were declined ECMO due to contraindications/futility (20 VV, 4 VA, 7 ECPR) and continued to be managed by MICU with 9.7% survival all deaths occurred within minutes to hours of ECLS consult; Dispositions were 33.3% Home and 66.6% LTAC for MV weaning 36, 61 and 65 days s/p ECLS consulted respectively. 11 patients were declined ECMO due to not meeting criteria as BenefitsRisks (10 VV, 1 VA) and continued to be managed by MICU with 54.5% survival 3 asthma, 2 transferred for organ transplant evaluation, and 1 COVID while all deaths were COVID-ARDS and occurred mean 9.6d s/p ECLS consult; Dispositions were 66.7% Home and 33.3% to another facility. 3 patients (all VV consults) were managed by ECLS service w/o ECMO for a period of time (mean 2.7d) and then subsequently managed by MICU with 0% survival; deaths occurred mean 12d s/p ECLS signed-off 2 COVID-ARDS and 1 TRALI. Conclusion ECMO consults from the MICU at our facility had ELSO criteria applied for selection and had outcomes on ECMO consistent with published standards; ECLS service was able to avoid ECMO in many cases with excellent functional outcomes. Improvements can be made in decisions on timing of consults and co-management of patients This abstract is funded by: None
Shiber et al. (Fri,) studied this question.