ECMO: When to Request Consultation or Transfer

Why Early Referral Matters

ECMO is often used as a last-line intervention for patients who may not survive without temporary support. But that does not mean referring providers should wait until every option has been exhausted before calling.

Early consultation can help our team determine whether:

• ECMO is needed
• Another intervention may be appropriate
• Mechanical support can be avoided altogether

If ECMO becomes necessary, earlier involvement may allow the team to initiate support in a more controlled and planned way.

Early transfer can also preserve future treatment options. For patients with cardiogenic shock or advanced heart failure, evaluation for transplant or durable mechanical support is often easier before complications such as stroke, end-organ injury, or prolonged instability develop.

“Evaluating patients for transplant or LVAD early in their ECMO course is far easier than doing so after complications such as stroke or end-organ injury develop,” Beller says. “Early transfer helps reduce those risks and preserves future options.”

What Happens When You Contact UVA Health

UVA Health recently established a multidisciplinary shock team to evaluate patients in cardiogenic shock or with an impending need for mechanical support. The team includes interventional cardiologists, heart failure specialists, cardiac surgeons, and ECMO specialists.

When a referring provider contacts UVA Health, the team can review the patient’s imaging, hemodynamics, clinical history, and current support needs to help guide the next step.

Not every patient qualifies for ECMO or advanced therapies. But early review is valuable whether or not the patient ultimately needs ECMO.

“Early identification of noncandidates remains just as important as identifying those who may benefit,” Beller says.

You can assist our team by having this information ready when you call:

• Diagnosis and clinical trajectory
• Current hemodynamics
• Vasopressor or inotrope needs
• Lactate level
• Echocardiogram findings
• End-organ function
• Neurologic status
• Bleeding risk
• Current mechanical support
• Relevant imaging
• For respiratory failure: ventilator settings and recent blood gas results

ECMO Transport & Cannulation Support

Some patients arrive at UVA Health already cannulated for ECMO. In select cases, when a patient is at a hospital without the ability to cannulate for ECMO, our team can perform cannulation at the referring hospital and transport the patient to UVA Health for ongoing care.

UVA Health’s ECMO Expertise

UVA Health treats approximately 75-100 adult ECMO patients each year in the Cardiovascular Intensive Care Unit. The program is one of only two ECMO programs in Virginia designated a Platinum Center of Excellence by the Extracorporeal Life Support Organization (ELSO).

Our cardiothoracic ICU manages all adult ECMO patients and is staffed around the clock with intensivists and cardiac surgeons. Heart failure cardiologists remain closely involved when patients may need advanced therapies such as LVAD or transplant.

The program also includes highly trained ECMO specialists with backgrounds in nursing, respiratory therapy, and perfusion. These specialists provide continuous bedside support for ECMO patients.

UVA Health’s ECMO leadership also plays an active role nationally through ELSO, helping shape how clinicians use data, quality benchmarks, and outcomes research to guide patient care. Dustin Money, senior ECMO specialist, was recently named inaugural chair of the ELSO Registry Quality Committee. Akram Zaaqoq, MD, director of UVA Health’s cardiothoracic ICU, serves as co-chair of the ELSO Registry Scientific Oversight Committee.

Supporting Patients Beyond ECMO

For patients who stabilize on VA ECMO, the next step may include transition to less invasive temporary mechanical support, such as an Impella device. This can allow patients to continue rehabilitation while the team assesses recovery or completes evaluation for transplant or durable LVAD.

“This year, we cared for many patients who arrived at UVA Health critically ill, stabilized on ECMO, transitioned to temporary LVAD support, received a transplant, and returned to functional lives,” Beller says. “Early referral and coordinated care make those outcomes possible.”