Core components of transitional care for ECMO survivors after ICU discharge: a three-round modified Delphi study

BACKGROUND: Survivors of extracorporeal membrane oxygenation (ECMO) may experience persistent physical, cognitive, psychological, social, and quality-of-life impairments after intensive care unit (ICU) discharge. However, the core components of early transitional care after ECMO remain insufficiently defined. OBJECTIVE: To identify clinician-derived core components of an early transitional care framework for adult ECMO survivors after ICU discharge in Portugal. METHODS: We conducted a three-round modified Delphi consensus study with clinicians from the three Portuguese ECMO referral centers. Candidate items were informed by a scoping review, a cross-sectional study of national follow-up practices, and synthesis by the steering group. Panellists rated the importance of each item for inclusion in an early transitional care framework using a 5-point scale. Consensus was predefined as ≥70% of panellists rating an item as 5. Non-consensual items were revised or excluded based on quantitative feedback and qualitative comments. RESULTS: Nine experts completed all three rounds. The final framework included 19 consensual components across four domains: objectives of care, clinical assessment and instruments, structure and timing of care delivery, and professional involvement. The framework supports early, staged follow-up beginning during ICU stay, continuing at ICU discharge, and extending into the first month after ICU discharge. CONCLUSION: This study provides an initial clinician-derived consensus framework for early transitional care after ECMO in Portugal. The framework should not be interpreted as a definitive survivorship model. Further work should include survivors, caregivers, and broader multidisciplinary stakeholders, and should evaluate implementation, feasibility, and longer-term follow-up beyond the first month.