1135: Ecmo Decision-Making: Outcomes Associated With Use of a Team-Based Process

Introduction: Strategies for extracorporeal membranous oxygenation (ECMO) candidacy decision-making differ within and between institutions. A subset of PICU faculty at Seattle Children’s Hospital who serve as ECMO consultants to the larger PICU faculty developed a consensus-based process for decision-making in complex patients. We describe this process, discussion content, and outcomes. Methods: The process evaluates patients who may require ECMO but for whom decision-making on ECMO-eligibility is complex or unclear. Medical information is shared with the ECMO consultant group, who discusses the case until consensus is achieved. Given differences in outcome, ECPR and planned ECMO cannulation are considered separately. The consensus decision on ECPR/ECMO eligibility is shared with the medical team and documented in the EMR. We identified children admitted to PICU under 18 years of age from 5/1/2021– 3/27/2025 who were discussed for ECMO candidacy via the decision-making process or received ECMO without discussion. We abstracted ECMO decision-making content and candidacy conclusions from the hospital-based secure messaging platform. Descriptive statistics were used. Results: 21 patients were discussed for ECMO candidacy, while 59 patients received ECMO over the study period. Discussion content included consideration of technical limitations, relative contraindications, prognosis related to the acute illness and chronic or underlying illnesses, and ECMO-specific risk stratification based on known epidemiologic risk factors influencing ECMO outcomes. Discussions concluded that 2 (9.5%) of discussed patients should be offered ECPR/ECMO, 1 (4.8%) should be offered ECPR/ECMO with constraints, and 5 (23.8%) should not be offered ECPR but should be offered ECMO with constraints. For the remaining 13 (61.9%), consensus was that ECPR/ECMO should not be offered. Only two of the discussed patients received ECMO. Conclusions: The majority of patients who received ECMO did not require candidacy discussions. For those discussed, the team most often recommended ECMO restrictions, reflecting significant medical complexity and concern for poor prognosis. Our consensus-based evaluation process supports individualized risk/benefit assessment to minimize potential bias and provides a consistent approach.