Lee et al.6) reported that a multidisciplinary team approach was associated with improved clinical outcomes in in-hospital cardiac arrest patients undergoing ECPR in the emergency department. The importance of the multidisciplinary team for patients with cardiac arrest has been emphasized in the guidelines and consensus2)7); however, there are few reports on the association between the multidisciplinary team approach and the clinical outcome. Lee et al.6) investigated the association in 125 patients who underwent ECPR in a single-center observational analysis. Although no differences were shown in the clinical outcomes between the pre-ECMO team and the post-ECMO team in the overall population, a multidisciplinary team approach was reported as a key factor in improving clinical outcomes for patients with in-hospital cardiac arrest. Lee et al.6) suggested that more active preemptive approach and appropriate follow-up protocol for cardiac arrest via the multidisciplinary team would result in the improvement of the clinical outcomes.

The most important factor for improving overall survival in patients with cardiac arrest is the minimization of CPR time.2) In this study,6) the patients who received treatment from the post-ECMO team, defined as a multidisciplinary team, resulted in significant reductions in chest compression time and CPR-to-ECMO-pump-on-time. In addition, a multidisciplinary team approach was particularly effective in improving the clinical outcome of patients with in-hospital cardiac arrest. It could be self-explainable that clinical outcomes of in-hospital cardiac arrest are superior to those from out-of-hospital cardiac arrest, probably due to reduced delays in initiation of high-quality CPR,8) and a similar result was shown in this study.6) Although improvement in clinical outcomes after the multidisciplinary team approach was not shown in all populations such as patients with out-of-hospital cardiac arrest in this study, it could be explained by inevitable characteristics of patients with out-of-hospital cardiac arrest (i.e., time delay to hospital visit). Thus, the potential of the multidisciplinary team approach should be more emphasized for the management of patients with in-hospital cardiac arrest.

Another benefit of the multidisciplinary team approach was post-cardiac arrest care. In this study, the multidisciplinary ECMO team performed more distal perfusion catheters insertion and used less mechanical ventilation.6) Therefore, the multidisciplinary ECMO team could reduce complications including limb ischemia, ventilator-induced diaphragm dysfunction, and ventilator-/intubation- associated pneumonia, delirium, and could facilitate enhanced rehabilitation. Not only preemptive approaches (ECPR) but also proper post-ECPR management could be translated to improvement in the clinical outcomes in this study. Accordingly, the guidelines emphasize the need for a multidisciplinary system for comprehensive and structured management.2)9)

Expert consensus recommends that an institution providing ECPR should engage in a multidisciplinary process between clinicians and administrators to include: a needs assessment, program feasibility and sustainability, expectations, and resource availability.7)10) Lee et al.6) showed an excellent representative case of a multidisciplinary team, which consisted of emergency physicians, interventional cardiologists, critical care physicians, cardiovascular surgeons, heart failure physicians, a pharmacist, a nutritionist, and perfusionists, and demonstrated how it worked. In conclusion, a multidisciplinary team approach should be performed to improve clinical outcomes in patients with cardiac arrest.