Effects of a dual-team collaboration model guided by chain management on ECMO initiation and clinical outcomes in critically ill patients: a quasi-experimental study

Objectives To develop a chain management–based dual-team collaboration model integrating the rapid response team (RRT) and medical emergency team (MET) and to evaluate its effectiveness in ECMO management in the ICU. Methods A chain-based ECMO rescue system was established through literature review, expert consultation, and pilot testing. Fifty-six critically ill patients requiring ECMO were enrolled in a tertiary ICU. Patients admitted from January–December 2023 received conventional MET care (control group, n = 28), while those admitted from March 2024–February 2025 received the RRT–MET model (experimental group, n = 28). ECMO initiation time, team preparation and circuit priming times, early physiological indicators, complications, and 28-day outcomes were compared. Results The experimental group showed significantly shorter ECMO initiation, team preparation, and priming times (all p 0.05). In the VV-ECMO subgroup, oxygenation index improved at 4 h in both groups, and VV-ECMO duration was significantly shorter in the experimental group ( p 0.05), but this difference did not remain significant after multivariable adjustment ( p = 0.23). Complications and 28-day survival favored the experimental group but were not statistically significant. In the VA-ECMO subgroup, blood lactate decreased at 4 h in both groups, and VA-ECMO duration tended to be longer in the experimental group ( p 0.05). Conclusion The chain management–based RRT–MET model effectively optimized ECMO activation and operational efficiency and was associated with improved process efficiency and showed trends toward improved clinical outcomes, although differences in survival and complications were not statistically significant. Implications for clinical practice This structured dual-team pathway enhances coordination, clarifies roles, and reduces delays during ECMO initiation, providing a scalable framework for optimizing emergency ECMO response in critical care settings. Clinical trial registration ChiCTR2500103232.